GENERAL STRUCTURE OF THE GASTROINTESTINAL TUBE
Mucous membrane (tunica mucosa):
Folds (plicae), smaller processes (papillae), villi (villi intestinales). Lamina epithelialis,
lamina propria mucosae, lamina muscularis mucosae. Folliculi lymphatici solitarii or
folliculi lymph. aggregati – Peyer’s patches.
Submucous tissue (tunica submucosa)
The nervous plexus is called plexus submucosus Meissneri.
Muscular tissue (tunica muscularis)
Striated or smooth musculature. Internal circular and external longitudinal. The nervous
plexus myentericus Auerbachi.
Outer layer
Tunica adventitia or tunica serosa (visceral peritoneum).
Glands of the GIT
Intramural (e.g. goblet cells) or extramural glands.
ORAL CAVITY (CAVUM ORIS)
Rima oris
Vestibulum oris
Cavum oris proprium
Vestibule of the mouth (vestibulum oris)
Labia oris - labium superius – sulcus nasolabialis, philtrum - tuberculum labii superioris
cheiloschisis (cleft lip)
gnathoschisis (cleft jaw)
palatoschisis (cleft palate)
- labium inferius - sulcus mentolabialis
pars intermedia
fornix vestibuli superior et inferior - frenulum
anguli oris
glandulae labiales
m. orbicularis oris.
Buccae - glandulae buccales, m. buccinator, papilla parotidea - ductus parotideus.
Raphe pterygomandibularis – mandibular anesthesia
Gingiva - gingiva proper (attached gingiva) - pars fixa gingivae
- pars libera gingivae
Alveolar mucosa – separated from the gingiva by the mucogingival border
The oral cavity proper (cavum oris proprium)
diaphragma oris - mylohyoid muscles, geniohyoid muscles, anterior belly of the digastric
muscle
glandula submandibularis
glandula sublingualis
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Salivary glands
Glandulae salivariae minores - labiales, buccales, molares, palatinae, linguales
Glandulae salivariae majores - sublingualis, submandibularis and parotis
Glandula submandibularis – ductus submandibularis – caruncula sublingualis
Glandula sublingualis– plica sublingualis, ductus sublingualis major, ductus
sublinguales minores
Glandula parotis - fossa retromandibularis, fascia parotideomasseterica.Tractus angularis
separates the gland from the trigonum submandibulare. Parotid plexus - CN VII – nervus
facialis.
Ductus parotideus - papilla parotidea
Glandula parotis accessoria
Palate (palatum)
Hard palate (palatum durum) - palatine processes of the maxillae and horizontal plates of
the palatine bones
Raphe palati
Papilla incisiva
Plicae palatinae transversae
Glandulae palatinae
Soft palate (palatum molle, velum palatinum)
Aponeurosis palatina
Uvula palatina
Arcus palatoglossus et arcus palatopharyngeus
Tonsilla palatina – fossa (sinus) tonsillaris, plica triangularis, fossa supratonsillaris–
plica semilunaris, 12 – 15 cryptae tonsillares– tonsillitis – tonsillar pegs, paratonsillar
vein - tonsillectomy.
Muscles of the soft palate:
Musculus tensor veli palatini – CN V.
M. levator veli palatini
M. uvulae
M. palatoglossus
M. palatopharyngeus
plexus pharyngeus (CN IX., X.).
Tongue (lingua)
Corpus linguae
Radix linguae - tonsilla lingualis
Dorsum linguae - sulcus terminalis (ductus thyroglossus), sulcus medianus
Papillae filiformes, fungiformes, foliatae, valatae, (calliculi gustatorii)
Apex linguae
Margines linguae
Facies inferior linguae - frenulum linguae, plicae fimbriatae, plica sublingualis
-caruncula sublingualis
Plica glossoepiglottica mediana and two plicae glossoepiglotticae laterales - valleculae
epiglotticae
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DENTITION
Dentes permanentes
32 teeth: 2 incisors, 1 canine, 2 premolars and 3 molars in one quadrant of the complete
permanent dentition.
Description of the tooth:
Crown (corona dentis)
Masticatory surface (facies occlusalis) - tubercula dentalia
Contact ss. (facies approximales) - facies mesialis, facies distalis
Vestibular s. (facies vestibularis) - f. labialis, f. buccalis
Oral s. (facies oralis) - f. palatina, f. lingualis
Neck (collum dentis) - gingivodental cap
Root (radix dentis)
Pulp cavity (cavitas dentis) - canalis radicis - foramen apicis dentis
Structure of the tooth
Dentin (dentinum) formed by odontoblasts, 70% of inorganic substances.
Enamel (enamelum) 97% of inorganic substances.
Cement (cementum) formed by the fibrous bone.
Pulp (pulpa dentis) - areolar connective tissue, vessels and nerves.
Fixation of the tooth
Periodontium - collagen Sharpey’s fibers
Parodontium - gum, periosteum, alveolus, periodontium, cement
Morphology of individual teeth
Dens incisivus -1 root, crown - occlusal edge. The largest incisor is upper medial one. The
root is long, conical and flat from sides.
Dens caninus are long teeth with one root, the crown projects in the acute spike with cutting
edges at its sides. The root is long and flat from sides. The upper canine is bigger than lower.
Dens premolaris has 2 tubercles on its occlusal surface (one vestibular, the other lingual).
Upper premolars have both tubercles of the same size, the lower have the bigger vestibular
tubercle. Premolars have one root except the upper first premolar that has two roots –
palatinal and buccal.
Dens molaris - the occlusal surface of upper molars has 4 tubercles separated by a deep
groove. The size of molars decreases distally. The crown has 2 buccal and 2 palatinal
tubercles. The groove has the shape of the letter H. Upper 1st
molar is the strongest and
biggest tooth of the upper arch. The additional tubercle may be on its palatine side
(tuberculum anomale Carabelli). Upper 2nd
and 3rd
molars have often only 2 tubercles.
The occlusal surface of the lower molars has the quadrangular shape. The groove has the
shape of the cross. The 1st
molar has often 5 tubercles the 5th
lies distally.
Third molars have variable crowns and may be impacted. Upper molars have 3 roots (2
vestibular and 1 palatinal), lower have 2 roots (1 mesial and 1 distal)
Dentes decidui
Crowns of milk teeth are lower and wide. They are of white colour with a blue shade. Roots
are narrower and sharper and are more distant because they surround crowns of permanent
teeth.
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Dental formula
i1, i2, c, m1, m2 (I, II, III, IV, V) – deciduous teeth
I1, I2, C, P1, P2, M1, M2, M3 (1, 2, 3, 4, 5, 6, 7, 8) – permanent teeth
Dentition is divided into 4quadrants:
1|2 5|6
4|3 8|7
permanent deciduous
23 = upper left permanent canine
85 = lower right milk second molar
Occlusion
Upper dental arch has a shape of the half of an oval, lower arch of an parabola. Therefore the
teeth do not meet each other exactly. Normally the crowns of the upper teeth direct slightly
forward and those of the lower teeth backward. Thus the cutting edges of the upper front teeth
lie anterior to that of lower front teeth like a pair of scissors. In the premolars and molars the
vestibular tubercles of upper teeth overhangs those of lower teeth. Each tooth is in contact
with two opposing teeth, with the principal antagonist (over a large contact area) and with an
adjacent secondary antagonist. Only the 1st
lower incisor and the third upper molar have a
single antagonist. In rare cases the cutting edges are opposite each other like a forceps. In
prognathism – the upper jaw is displaced anteriorly; in progenism – the lower jaw is anterior
to the upper one.
Eruption
The primordia of the deciduous teeth are already in a newborn child. The growing root pushes
the crown to the gum, which atrophies and the tooth erupts.
I 6th
-8th
month
II 8th
-12th
month
III 16th
-20th
month
IV 12th
-16th
month
V 20th
-36th
month
Exchange of the teeth
Crowns of the permanent teeth grow orally and elicit resorption of alveoli of milk teeth and
their roots. Roots of milk teeth shorten and disappear, the rest of the crown releases from the
gum.
1 7th
-8th
year
2 8th
-9th
year
3 11th
-13th
year
4 9th
-11th
year
5 11th
-13th
year
6 6th
-7th
year
7 12th
-14th
year
8 17th
-40th
year
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PHARYNX
fornix pharyngis
pharyngeal recess
cavum pharyngis
fascia pharyngobasilaris
Pars nasalis pharyngis (nasopharynx)
choanae
ostium pharyngeum tubae auditivae - torus tubarius - plica salpingopharyngea, plica
salpingopalatina, torus levatorius
tonsilla pharyngea - fornix pharyngis
tonsilla tubaria
Waldeyer’s lympfoepithelial ring
Pars oralis pharyngis (oropharynx)
a. isthmus faucium
Pars laryngea pharyngis (laryngopharynx)
2. aditus laryngis - epiglottis, aryepiglottic folds
3. recessus piriformis
4. plica n. laryngei
Muscles of the pharynx
Constrictors - raphe pharyngis
M. constrictor pharyngis superior:
1. Pars pterygopharyngea –lamina medialis proc. pterygoidei
2. Pars buccopharyngea –raphe pterygomandibularis
3. Pars mylopharyngea –linea mylohyoidea mandibulae
4. Pars glossopharyngea – transverse muscle of the tongue
M. constrictor pharyngis medius:
1. Pars chondropharyngea –cornu minus ossis hyoidei
2. Pars ceratopharyngea - cornu majus ossis hyoidei
M. constrictor pharyngis inferior:
1. Pars thyropharyngea –linea obliqua of the thyroid cartilage
2. Pars cricopharyngea – cricoid cartilage
Levators:
M. stylopharyngeus – from the processus styloideus caudally and medially - the fissure
between the superior and middle constrictors.
M. palatopharyngeus
M. salpingopharyngeus – from the cartilaginous part of the auditory tube
The pharynx actively participates in swallowing, respiration and phonation. During
swallowing the muscles of the soft palate open the auditory tube to ventilate the tympanic
cavity.
5
Mechanism of the deglutition
The first stage of the swallowing is voluntary: the anterior part of the tonge is raised and
pressed against the hard palate. A bolus is pushed dorsaly. The hyoid bone is is moved up and
forwards by the suprahyoid muscles. The root of the tonge is drawn up and back and
palatoglossal arches are approximated, pushing the bolus through the isthmus of the fauces
into the oropharynx.
The second stage is involuntary. The soft palate is elevated, tightened and firmly
approximated to the posterior pharyngeal wall (by the upper pharyngeal constrictor). Then the
larynx and pharynx is drawn up (stylopharyngeus, palatopharyngeus, thyrohyoid muscles).
Simultaneously, the aryepiglottic folds are approximated and epiglottis bends back onto the
laryngeal inlet excluding the bolus from the larynx. The bolus slips into the lowest part of the
pharynx.
The last stage is the expulsion of the bolus into the oesophagus, by the inferior constrictors.
OESOPHAGUS
1) Pars cervicalis
2) Pars thoracica
pars retrotrachealis
pars retropericardiaca
3) Pars abdominalis - cardia - gastrooesophageal junction
3 physiological narrowings
hiatus oesophageus
adventitia, serosa
oesophagoscopy, oesophagography
STOMACH (GASTER, VENTRICULUS)
regio hypochondriaca sinistra
J-shaped stomach, steer horn (transverse type)
cardia
pars cardiaca
fundus (fornix) ventriculi - stomach bubble
incisura cardiaca
corpus ventriculi - canalis gastricus
pars pylorica - antrum pyloricum, canalis pyloricus
pylorus - ostium pyloricum
paries anterior
paries posterior
curvatura minor - incisura angularis
curvatura major
Functionally:
Pars digestoria (digestive segment) - fundus and canalis gastricus.
Pars egestoria (evacuating segment) - gastric sinus (antrum) and canalis pyloricus
Plicae gastricae– sulcus salivarius
Mucinous glands – mucus
Tubulous glands - succus gastricus
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Areae gastricae - foveolae gastricae
Musculature – fibrae obliquae
- stratum circulare - m. sphincter pylori
- stratum longitudinale
After the stomach is filled the musculature contracts and is in the rest (peristole), the mucosa
adheres to the content (20 min). Then rhythmical contractions (peristalsis) begin. Peristaltic
waves start in the cardia each 15 -30 seconds and get to the pylorus in 60 seconds. Four waves
may be seen together at the X-ray picture. Peristalsis serves for the mixing of the content to
the pulpy chyme that in small portions is emptied to the duodenum.
Omentum minus – lig. phrenicogastricum, hepatogastricum, hepatoduodenale
Omentum majus - lig. gastrocolicum, lig. gastrolienale
INTESTINUM
Intestinum tenue
ansae intestinales
Duodenum
pars superior - bulbus duodeni
flexura duodeni sup.
pars descendens duodeni
flexura duodeni inf.
pars horizontalis
pars ascendens
flexura duodenojejunalis
plicae circulares Kerkringi
villi intestinales
crypts of Lieberkuhn – glandulae intestinales
glandulae duodenales Brunneri
plica longitudinalis duodeni - papilla duodeni major Vateri
- papilla duodeni minor
Jejunum and ileum - jejunoileum
JEJUNUM ILEUM
upper left part of the
inframesocolic space
lower right part of the
inframesocolic space
wider (3-4 cm) narrower (2-3 cm)
more plicae circulares fewer plicae circulares
1-2 arcades 2-3 arcades
folliculi lymph. solitarii folliculi lymph. aggregati
mesenterium
ostium ileocaecale - valva ileocaecalis
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INTESTINUM CRASSUM
intestinum caecum
appendix vermiformis
colon ascendens
flexura coli dextra – hepatica
colon transversum
flexura coli sinistra – lienalis
colon descendens
colon sigmoideum
rectum
mucosa - unilayered columnar epithelium, intestinal glands, lymphatic follicles
submucosa - vascular and nerve plexuses
circular musculature – plicae semilunares, haustra coli
longitudinal musculature - taenia mesocolica
12 taenia omentalis
13 taenia libera
visceral peritoneum - appendices epiploicae
Intestinum caecum
recessus retrocaecalis
caecum liberum – mesocaecum
ostium ileocaecale
valva ileocaecalis (Bauhini) - labium sup. et inf.
Appendix vermiformis (tonsilla abdominalis)
ostium appendicis vermiformis – valva appendicis vermiformis
mesoappendix
positio pelvina (32%) - ligamentum appendiculoovaricum
positio retrocaecalis (64%)
positio ileocaecalis
positio laterocaecalis
positio subcaecalis
positio praecaecalis
Projection of the appendix:
McBurney`s point - linea spinoumbilicalis dextra - Monro’s line
Lanz’s point
Rectum
crena ani- anus
Ampulla recti - flexura sacralis
- plicae transversae recti - Kohlrausch`s fold
- flexura perinealis
linea anorectalis
Canalis analis – zona hemorrhoidalis - columnae anales
- sinus anales
- valvulae anales
- pecten analis
linea anocutanea
plexus venosus rectalis
m. sphincter ani internus - m. sphincter ani externus – voluntary control of defecation.
8
INTESTINUM CRASSUM
intestinum caecum
appendix vermiformis
colon ascendens
flexura coli dextra – hepatica
colon transversum
flexura coli sinistra – lienalis
colon descendens
colon sigmoideum
rectum
mucosa - unilayered columnar epithelium, intestinal glands, lymphatic follicles
submucosa - vascular and nerve plexuses
circular musculature – plicae semilunares, haustra coli
longitudinal musculature - taenia mesocolica
5. taenia omentalis
6. taenia libera
visceral peritoneum - appendices epiploicae
Intestinum caecum
recessus retrocaecalis
caecum liberum – mesocaecum
ostium ileocaecale
valva ileocaecalis (Bauhini) - labium sup. et inf.
Appendix vermiformis (tonsilla abdominalis)
ostium appendicis vermiformis – valva appendicis vermiformis
mesoappendix
positio pelvina (40%) - ligamentum appendiculoovaricum
positio retrocaecalis (15-30%)
positio ileocaecalis
positio laterocaecalis
positio subcaecalis
positio praecaecalis
Projection of the appendix:
McBurney`s point - linea spinoumbilicalis dextra - Monro’s line
Lanz’s point
Rectum
crena ani- anus
Ampulla recti - flexura sacralis
- plicae transversae recti - Kohlrausch`s fold
- flexura perinealis
linea anorectalis
Canalis analis – zona hemorrhoidalis - columnae anales
- sinus anales
- valvulae anales
- pecten analis
linea anocutanea
plexus venosus rectalis
9
m. sphincter ani internus
m. sphincter ani externus – voluntary control of defecation.
LIVER (HEPAR)
Facies diaphragmatica - pars superior (area nuda – bare area)
- pars anterior (covered by peritoneum)
lig. coronarium - lig. triangulare dextrum
- lig. triangulare sinistrum - appendix fibrosa hepatis
lig. falciforme hepatis - lobus dexter hepatis
- lobus sinister hepatis
lig.teres hepatis (v. umbilicalis)
Facies visceralis - fissura sagittalis dextra - sulcus v. cavae inf. (lig. venae cavae ), fossa
vesicae biliaris
- fissura sagittalis sinistra – lig. teres hepatis, lig. venosum (ductus venosus)
- porta hepatis- vena portae, a. hepatica propria, ductus hepaticus communis
lobus caudatus - processus caudatus
lobus quadratus
lobus dexter - impressio renalis, suprarenalis, duodeni, colica
lobus sinister – tuber omentale, impressio oesophagea, gastrica
Hepatic segments (Couinaud)
lobus caudatus – 1st
segment
lobus sinister - 2nd
to 4th
segments
lobus dexter - 5th
to 8th
segments
Cantlie`s line
Structure of the liver
capsula fibrosa- capsula fibrosa perivascularis
lobulus venae centralis (hepaticus)
Glisson`s triad – a., v., ductus interlobularis
sinusoids
trabeculae
v. centralis
v. sublobularis
v. hepatica
Blood flow in the liver
functional circulation – v. portae
nutritive circulation – a. hepatica propria
Intrahepatic bile ducts:
canaliculus bilifer
ductus bilifer intralobularis
ductulus bilifer
ductus bilifer interlobularis
10
Extrahepatic bile ducts:
ductus hepaticus dexter et sinister
ductus hepaticus communis
ductus cysticus
ductus choledochus - m. sphincter ductus choledochi
Vater`s papilla (papilla duodeni major)- m. sphincter ampullae hepatopancreaticae (Oddi)
The liver fills the whole right diaphragmatic dome and reaches over the midline to the left
diaphragmatic dome where it reaches the left midclavicular line. The lower border of the liver
follows the right costal arch to the right midclavicular line (9th
costal cartilage) where it
ascends obliquely toward the end of the left 8th
costal cartilage. This part of the liver between
costal arches is in contact with the anterior abdominal wall. The superior part neighbors
through the diaphragm with the right lung and the heart in the pericardium.
Vesica biliaris (fellea)
fundus
corpus
infundibulum
collum
ductus cysticus- plica spiralis
The fundus of the gallbladder is in contact with the anterior abdominal wall in the crossing of
the right midclavicular line and the 9th
costal cartilage.
PANCREAS
caput - incisura pancreatis - processus uncinatus
corpus - tuber omentale
cauda
capsula pancreatis
facies anterior
facies posterior
margo superior
margo inferior
ductus pancreaticus major - m. sphincter ductus pancreatici - papilla duodeni major (Vateri)
ductus pancreaticus accessorius (minor) - papilla duodeni minor
succus pancreaticus
islets of Langerhans - insulin, glucagon
The head of the pancreas lies in front of the L2.
SPLEEN (LIEN, SPLEN)
extremitas anterior
extremitas posterior
margo superior - crenae lienis
margo inferior
facies diaphragmatica
facies visceralis - hilum lienis - facies gastrica, facies renalis, facies colica
capsula fibrosa
red pulp
white pulp
segments
11
The spleen reaches from the 9th
to the 11th
ribs, the anterior pole does not reach over the
costoarticular line – the connection between the end of the 11th
costal cartilage and left
sternoclavicular joint. In healthy man the spleen is not palpable. The posterior pole is about 4
cm from the 10th
vertebra.
PERITONEUM
peritoneum parietale
peritoneum viscerale
cavitas peritonealis - pars supramesocolica
- pars inframesocolica
spatium retroperitoneale
spatium subperitoneale
spatium preperitoneale
Intraperitoneal organs: stomach, bulbus duodeni, jejunoileum, appendix vermiformis, colon
transversum, colon sigmoideum, liver and spleen
The supramesocolic part - stomach, superior part of the duodenum, liver with bile ducts,
spleen - truncus coeliacus
The inframesocolic part - coils of the small intestine, large intestine - a. mesenterica sup. et
inf.
Secondarily retroperitoneal organs: most of the duodenum, caecum, colon ascendens,
descendens, pancreas
PERITONEAL FOLDS
omentum minus – lig. hepatogastricum
- lig. hepatoduodenale
omentum majus - lig. gastrocolicum
mesenterium - radix mesenterii
mesocolon transversum
mesoappendix vermiformis
mesocolon sigmoideum
lig. gastrosplenicum (-lienale)
lig. phrenicosplenicum (-lienale)
lig. splenorenale
lig. phrenicocolicum
RECESSUS PERITONEI
herniae internae
bursa omentalis - foramen epiploicum – vestibulum, recessus superior, splenicus, inferior
recessus duodenales: recessus duodenalis inferior - plica duodenalis inf.
recessus duodenalis superior - plica duodenalis sup.
recessus duodenalis sinister - plica duodenalis lat. - v. mesenterica inf.
recessus retroduodenalis
recessus ileocaecalis sup. - plica ileocaecalis sup.
recessus ileocaecalis inf. - plica ileocaecalis inf.
recessus retrocaecalis
recessus paracolici
recessus intersigmoideus
12