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 - taenia omentalis - 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 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 – 1^st segment lobus sinister - 2^nd to 4^th segments lobus dexter - 5^th to 8^th 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 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 vault where it reaches the left midclavicular line. The lower border of the liver follows the right costal arch to the right midclavicular line (9^th costal cartilage) where it ascends obliquely toward the end of the left 8^th 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 9^th 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 The spleen reaches from the 9^th to the 11^th ribs, the anterior pole does not reach over the costoarticular line – the connection between the end of the 11^th costal cartilage and left sternoclavicular joint. In healthy man the spleen is not palpable. The posterior pole is about 4 cm from the 10^th 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