ANATOMY – dentistry – DS II1 Digestive system – part II RNDr. Michaela Račanská, Ph.D. https://int.search.tb.ask.com/search/AJimage.jhtml?&searchfor=Medical+humor+liver&n=780ce2c7&p2=%5EAW7%5Exdm055%5ES10989%5Ecz&ptb=9E5 DBCE2-6DD1-4C8B-BF4C- D039F5413D4D&qs=&si=YO_SAF_INTL_CZE_45&ss=sub&st=hp&trs=wtt&tpr=sbt&ts=1520073482359&imgs=1p&filter=on&imgDetail=true Regio hypochondriaca dx. + regio epigastrica LIVER  Peritoneal cavity  Exocrine gland  Production of the bile  Another metabolic functions…. Fixation:  VCI (course)  Diaphragma (fusion)  Internal abdominal organs  Folds of peritoneum 1.5 kg Surface covered by: capsula fibrosa Tunica serosa lig. falciforme lig. teres hep. ligg. coronaria ligg. triangularia lobus dx. lobus sin. Facies diaphragmatica - pars anterior - pars sup. (area nuda, bare area) Facies diaphragmatica Apex fibrosa hepatis l. dx. l. sin. Porta hepatis Fissura lig. teretis Fissura lig. venosi Fossa vesicae biliaris Sulcus VCI Porta hepatis: v. portae a. hepat. propria dct. hepat. dx., sin. – com. Facies visceralis stomach kidney12C Fissurasagittalissin. lig. venae cavae Fissurasagittalisdx. Tuber omentale V. umbilicalis > lig. teres hepatis Dct. venosus > lig. venosum Fetus ADULT 1. lig. hepatogastricum 2. lig. hepatoduodenale: Omentum minus v. portae a. hepatica propria dct. choledochus Functional - v. portae Nutritional - a. hepatica it branches….until circumlobular vessels > sinusoids > v. centralis … vv. hepaticae - VCI Circulation of the blood Capsula fibrosa – capsula fibrosa perivascularis - v. interlobularis, a. interlobularis, ductus interlobularis sinusoids v. centralis Lobulus venae centralis V. PORTAE (v. mesenterica sup. + v. lienalis) A. HEPATICA PROPRIA - ramus dexter et sinister........... aa. et vv. interlobulares, aa. et vv. circumlobulares sinusoids v. centralis vv. sublobulares vv. hepaticae Hepatic lobulus = lobulus v. centralis: Liver structure  Fibrous capsule, below capsula fibrosa perivascularis enclose branches of the portal triad  Separate cells, polygonal hepatic lobules hepatocytes arranged in trabeculae (laminae) separated from each other by sinusoids  in the middle is v. centralis PORTAL ACINUS – functinal unit, between 2 adjacent central veins Blood in sinusoids is washing hepatocytes > takes useful and unuseful substances - sinusoids are meeting in the middle - v. centralis V. centralis bile between trabeculas of hepotocytes are sinusoids, to hat are draining a. hepatica and v. portae FORMATION OF THE BILE Intrahepatic biliary ducts start at the border of 2 cells. Canaliculus bilifer – ductus bilifer intralobularis – ductulus bilifer - ductus bilifer interlobularis – collecting ducts Extrahepatic bile ducts ductus hepaticus dexter et sinister – ductus hepaticus communis + ductus cysticus = ductus choledochus (bile duct Biliary ducts a. interlobularis v. interlobularis dct. bilifer interlobularis Fundus Plica spiralis Collum Corpus Extrahepatic biliary ducts Ductus hepaticus comm. + dct. cysticus > bile duct Papilla duodeni major (Vater) Plica longitudinalis duodeni Ampulla hepatopancreatica M. sphincter ampullae hepatopancreaticae (Oddi) Infundibulum Vesica biliaris (fellea) 50 ml Cholecystography ERCP Endoscopic retrograde cholangiopancreaticography Pancreas Exocrine gl. (succus pancreat.) Endocrine gl. (insulin, glukagon) Abdominal cavity Behind the stomach Horizontally from duodenum to the spleen Grey-pink color 12-16 cm anterior posterior caput corpus cauda Incisura pancreatis, processus uncinatus Tuber omentale Parts Facies membrana retropancreatica (Treitz) Margo superior inferior Pr. uncinatus Origin of v. portae Exocrine panxcreas: Endocrine pancreas: capsula pancreatis, lobules - acin islets of Langerhans (1-2 milions) succus pancreaticus insulin, glucagon – hormons to the blood ductus pancreaticus ductus pancreaticus accessorius m. sphincter ampullae hepatopancreaticae m. sphincter ductus choledochi m. sphincter ductus pancreatici Dct. pancreat. major +dct. choledochus Thickened to the ampula hepatopancr. - m. sphincter papillae hepatopancr. (2 parts) > papilla duod. major Dct. pancreat. minor > papila duod. minor Umbilico-axillary line - point of Desjardin ERCP – endoscopic retrograde cholangiopancreatography Lien, spleen  Located in the abdominal cavity  Lenght cca 12 cm  Color- red purple Extremitas posterior anterior Margo superior inferior Facies diaphragmatica Facies visceralis Hilus lienis: a. lienalis v. lienalis Structure of the spleen Tunica fibrosa (capsula lienis) Trabeculae splenicae - fibrous Pulpa lienalis: white, red trabecula sinuses function Defense mechanism Extinction of erythrocytes blood reservoar White pulp Red pulp germ center lig. phrenico-lienalie lig. gastro-lienale lig. phrenico-colicum Costoarticular line CAVITAS ABDOMINALIS P – cavitas peritonealis Spatium extraperitoneale: A – spatium preperitoneale R – spatium retroperitoneale S – spatium subperitoneale (infraperitoneale) S 1. Parietal peritoneum 2. Visceral peritoneum Mesenteria = přechod connection of the wall with organs (vessels+ nerves) Onelayered squamous epithelium+ subserose tissue Peritoneum - serosa Pars supramesocolica above mesocolon transversum Liver, gallbladder, stomach, spleen, part of the pancreas and duodenum Cavitas peritonealis Pars inframesocolica below mesocolon transversum Part of the pancreas and duodenum, intestine Radix mesenterii devides it into: pars dx. et sin. Cavitas peritonealis Pars supramesocolica Truncus coeliacus Pars inframesocolica A. mesenterica superior Pars inframesocolica A. mesenterica inferior H G D L Peritoneal folds in the supramesocolic portion Lig. falciforme hep., lig. coronarium Omentum minus: lig. hepato-gastricum hepato-duodenale Omentum majus: lig. gastrocolicum Lig. gastro-lienale Lig. phrenico-lienale Lig. phrenico-colicum 1. Month i.u. Omentum minus - lig. hepatogastricum - lig. hepatoduodenale - a. hepatica propria - v. portae - ductus hepaticus comm. Omentum majus - lig. gastrocolicum Mesenterium Mesoappendix Mesocolon transversum Mesosigmoideum Peritoneal folds in inframesocolic portion During development – rotation of some organs – fusion of the mesenterias with peritoneum parietale > secondarily retroperitoneal organs  colon ascendens  colon descends  pancreas  duodenum - duodenum - ileocecum - colon asc. and desc. - colon sigmoideum - bursa omentalis Recessus peritonei Herniae internae Recessus duodenalis sup., inf., sinister, retroduodenalis Recessus intersigmoideus Bursa omentalis cr: liver, diaphragmatic lobe ca: colon transversum ve: stomach, omentum min. dors: pancreas, duodenum, kidney Space in supramesocolic portion of the abdominal cavity ve: lig. hepatoduodenale dors: lig. hepatorenale cr: liver ca: duodenum Foramen epiploicum /omentale (Winslow) Recessus sup., splenicus, inf. Bursa omentalis Recessus inferior bursae omentalis Illustrations 34, 43,45,47-49 were copied from: Čihák R: Anatomie 2 (Splanchnologia). Avicenum, zdravotnické nakladatelství, Praha, 1988. Remaining illustrations, photographs, and radiographs were copied from: Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München: Urban & Schwarzenberg, 1993