Dentistry – ANATOMY II – DIGESTIVE SYSTÉM – PART I1 DIGESTIVE SYSTEM ANATOMY II – DENTISTRY RNDr. Michaela Račanská, Ph.D. ANATOMY 2 Dentistry Spring 2018 LECTURES - WE:12-13,40 S4.5 SEMINARS – FRI:14-15,40 P2 1. Digestive system (oral cavity - rectum) Digestive system (oral cavity - rectum) Muscles of the head 2. Digestive system (liver, spleen, pancreas, peritoneum) Digestive system (liver, spleen, pancreas, peritoneum) Muscles of the neck and abdomen 3. Respiratory system, thyroid gland, parathyroid glands, thymus Respiratory system Muscles of the thorax and back 4. Urinary system, suprarenal glands Male genital system Urinary and male genital system 5. Female genital system Pelvic floor Female genital system Pelvic floor 6. Heart Heart 7. Arteries Arteries 8. Veins and lymphs Veins and lymphs 9. Structure of the spinal nerve Plexus brachialis, lumbalis et sacralis, Holiday 19.4. 10. Topography of the upper limb Plexus brachialis, lumbalis et sacralis, 11. Holiday 1.5. Topography of the upper limb 12. Holiday 8.5. Topography of the lower limb 13. Topography of the lower limb Oral examination: topography of the limbs Completition of the course  10 questions, 5 on upper, 5 on lower limb, for each 1 point  to get credit is need to get minimum of 6 point out of 10 Knowledges on the topography of the limbs in the end of the course! 95% attendance to the practicals, basic knowledges at the tests during each seminar on splanchnology HRADILOVÁ SVÍŽENSKÁ, Ivana, Michaela RAČANSKÁ a Petr DUBOVÝ. Anatomy : handbook of splanchnology and angiology. 1st ed. Brno: Masaryk University, 2014. 153 s. ISBN Liebgott, Bernard. The anatomical basis of dentistry. 3rd ed. Mosby, ISBN 0-323-06807 Frame Grimm: Regional Anatomy Atlas Sobotta, Netter ….. Where you can study from Book Schedule Frame II X-rays https://is.muni.cz/auth/el/1411/jaro2015/VSAN0232s/u m/53713703/handouts/index.html - handouts and schemes IS – Studying materials aZLAN0232p GASTROINTESTINAL TRACT – GIT (APPARATUS DIGESTORIUS) Oral cavity (Cavitas oralis) Pharynx Oesophagus Stomach (Ventriculus) Small intestine (Intestinum tenue) duodenum jejunum ileum Large intestine (Intestinum crassum) caecum colon rectum GLANDS - food intake - mechanical and chemical processing - absorption of fission products - removal of unnecessary, superfluous, harmful substances GLANDS OF GIT: exocrine endocrine Intramural (in mucose or submucouse tissue)  goblet cells  small salivary glands  glandulae duodenales Extramural (outside of the DG-wall)  great salivary glands  liver  pancreas Just between epithelial cells TUNICA MUCOSA TUNICA SUBMUCOSA TUNICA MUSCULARIS TUNICA ADVENTITIA (TUNICA SEROSA=visceral peritoneum) Nerve plexus Nerve plexus PLEXUS SUBMUCOSUS MEISSNERI PLEXUS MYENTERICUS AUERBACHI PLICAE VILLI INTESTINALES PAPILLAE FOLLICULI LYMPHATICI SOLITARII FOLLICULI LYMPH. AGGREGATI – PEYER’S PATCHES CAVUM ORIS (CAVITAS ORIS) Rima oris Isthmus faucium Lips, bucca, palatum, Diaphragm Tongue, teeth, tonsils, Salivary glands CAVUM ORIS - vestibulum oris - cavum oris proprium Labium superius Pars intermedia philtrum tuberculum labii sup. Labium inferius Anguli oris Sulcus nasolabialis mentolabialis Bucca - cheiloschisis - gnathoschisis - palatoschisis Lips and bucca skin subcutaneous tissue musculature Submucouse layer (glands) Mucosa Pars intermedia= red portion of the lips Corpus adiposum buccae Fornix vestibuli sup. - frenulum labii superioris Fornix vestibuli inf. - frenulum labii inferioris Papilla parotidea VESTIBULUM ORIS BUCCA Fornix vestibuli sup. et inf. Frenulum labii sup. et inf. Tremata Trigonum retromolare Alveolar mucosa Mucogingival border Gingiva - gingiva fixa (attached g.) - gingiva libera (marginal g.), gingival sulcus Paramarginal groove OCCLUSION (PROGNATHISM, PROGENISM) Glandulae labiales, buccales M. orbicularis oris M. buccinator Corpus adiposum buccae RAPHE PTERYGOMANDIBULARIS Membranous connection Between buccinator and upper sphincter of the pharynx (just between pterygoid proc. of the sphenoid and mandible CAVUM ORIS PROPRIUM Diaphragma oris DIAPHRAGMA ORIS - m. mylohyoideus (raphe mylohyoidea) - m. geniohyoideus - m. digastricus GLANDULAE SALIVARIAE MINORES - labiales, buccales, molares, palatinae, linguales GLANDULAE SALIVARIAE MAJORES - submandibularis - sublingualis - parotis TRIGONUM SUBMANDIBULARE - glandula submandibularis - nodi lymph. submandibulares GLANDULA SUBLINGUALIS Caruncula sublingualis: - ductus submandibularis - ductus sublingualis major Ductus sublinguales minores GLANDULA PAROTIS Fascia parotideomasseterica Tractus angularis Ductus parotideus Glandula parotis accessoria PAPILLA PAROTIDEA N. facialis (CN VII) - plexus parotideus V. retromandibularis A. carotis ext. SALIVARY GLANDS Sialography Palatum  durum  molle PALATUM Glandulae palatinae Aa. et vv. palatinae majores et minores Nn. palatini majores et minores N. napasopalatinus PALATUM DURUM p. osseum suturae palatinae sulci palatini foramen incisivum for. palatinum majus for. palatina minora spina nasalis post. Mucoperiost Raphe palati Papilla incisiva Plicae palatinae transversae Openings of small salivary glands PALATUM MOLLE (VELUM PALATINUM) Uvula Arcus palatoglossus Arcus palatopharyngeus Isthmus faucium Aponeurosis palatina m. levator veli palatini m. tensor veli palatini m. uvulae (uvula) m. palatoglossus (arcus) m. palatopharyngeus (arcus) Palatum molle Plexus pharyngeus – CN IX, X Tensor – CN V TONSILLA PALATINA Fossa tonsillaris Plica semilunaris Fossa supratonsillaris Plica triangularis Capsula tonsillaris Paratonsillar vein Cryptae tonsillares Tonsillar pegs LINGUA – APEX, CORPUS, RADIX Lingua (glossa) Radix: tonsilla lingualis Corpus: dorsum x facies inf., margines linguae Dorsum sulcus medianus sulcus terminalis foramen caecum (ductus thyroglossus) papillae linguales Plicae glossoepiglotticae Valleculae epiglotticae Glandulae linguales papillae: Filiformes Fungiformes Foliatae Valatae calliculi gustatorii Facies inferior linguae Plica fimbriata Frenulum linguae Plica sublingualis M. genioglossus M. hyoglossus M. styloglossus (M. palatoglossus) Extraglossal muscles (change the position of the tongue) M. hyoglossus M. styloglossus M. palatoglossus M. genioglossus Mm. longitudinales (sup. et inf.) M. transversus M. verticalis Own muscles of the tongue (change the shape of the tongue) Aponeurosis linguae Septum linguae Canalis paralingualis Canalis paralingualis – a. et v. lingualis N. lingualis N. hypoglossus (CN XII) N. glossopharyngeus (CN IX) A. lingualis Dentes Dentition ■ first dentition (primary, milk) ■ mixed ■ permanent (second) DENTES PERMANENTES DENTES INCISIVI - 2 DENS CANINUS – 1 DENTES PREMOLARES – 2 DENTES MOLARES – 3 CORONA DENTIS COLLUM DENTIS RADIX DENTIS CORONA: Facies occlusalis - tubercula dentalia Facies approximales - f. mesialis (prox.) - f. distalis Facies vestibularis - f. labialis - f. buccalis Facies oralis - f. palatina - f. lingualis CAVUM DENTIS CANALIS RADICIS DENTIS FORAMEN APICIS DENTIS GOMPHOSIS PERIODONTAL LIGAMENT (P. MEMBRANE; PARODONTIUM) Sharpey’s fibers enamelum dentinum cementum DENTES INCISIVI - 2 DENS CANINUS – 1 DENTES PREMOLARES – 2 DENTES MOLARES – 3 Tuberculum anomale Carabelli DENTES INCISIVI - 2 DENS CANINUS – 1 DENTES MOLARES - 2 DENTES DECIDUI Eruption: I 6th- 8th month I, II, IV, III, V II 8th-12th month III 16th-20th month IV 12th-16th month V 20th-36th month Exchange of the teeth: 1 7th-8th year 6, 1, 2, 4, 3, 5, 7, 8 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 PHARYNX Fornix pharyngis Cavum pharyngis Nasopharynx Choanae Oropharynx Isthmus faucium Laryngopharynx Aditus laryngis 6 2 4 Pharynx 12-15 cm RECESSUS PHARYNGEUS FASCIA PHARYNGOBASILARIS (LUSCHKA’S SEMILUNAR SPACE) Ostium phar. tubae auditivae, Tonsilla tubaria Torus tubarius (Plica salpingopharyngea ) Torus levatorius Plica salpingopalatina Tonsilla pharyngea Nasopharynx Epiglottis Plicae aryepiglotticae Incisura interaryt. Recessus piriformis Plica n. laryngei Oropharynx Isthmus faucium Tonsilla palatina Laryngopharynx Nasopharynx Choanae Waldeyer´s lymphoepithelial ring T.palatina T.lingualis T.pharyngea T.tubaria T.palatina T.tubaria Mm. constrictores Superius p. pterygop. buccop. mylop. glosso- Medius p. chondrop. cerato- Inferius p.thyrop. cricoraphe pharyngis LEVATORS M. stylopharyngeus M. palatopharyngeus M. salpingopharyngeus Spatium parapharyngeum Spatium retropharyngeum LIG. RETROPHARYNGEUM MEDIANUM Oesophagus cervicalis (6cm) - apertura thoracis sup. thoracica (15-20cm) •PARS RETROTRACHEALIS • PARS RETROPERICARDIACA - diaphragm abdominalis (1-2cm) Pars: 25 cm Th11 Curvatures in sagittal plane In frontal plane Connection to aorta thoracica ESOPHAGEAL CONSTRICTIONS adventitia / serosa submucosa musclemucosa Structure of the esophagus Reserve folds> Star shape section - striated - mixed - smooth (sphincter) muscle •Transitional epithelium–oesophagus and stomach - GASTROOESOPHAGEAL JUNCTION •OESOPHAGOGRAPHY Localization: peritoneal cavity - reg. hypochondriaca sin. shape Ventriculus (gaster) Triangle of Labbeé □ lower margin of the liver □ left arch of the rib □ transpyloric line Projection Cardia (Th 11) Pars cardiaca Fundus Corpus Pars pylorica Pylorus (L1-2) Paries anterior Paries posterior Curvatura major Curvatura minor Incisura cardiaca Incisura angularis 1l Ostium cardiacum Ostium pyloricum (m. sphincter pylori) Plicae gastricae Sulcus salivarius Canalis gastricus Canalis pyloricus Fundus ventriculi Areae gastricae - foveolae gastricae gll. gastricae (hlen; succus gastr.) Endocrine cells (gastrin …) 3 muscular layers: fibrae obliquae stratum circulare (m. sphincter pylori) stratum longitudinale (taenie curvaturae) Omentum minus: Omentum majus: serosa Lig. hepatogastricum + hepatoduodenale Lig. gastrocolicum + gastrolienale Incisura angularis Pars digestoria Pars egestoria Gastroscopy Intestinum Intestinum tenue 5-7m Duodenum flexura duodeno- jejunalis Jejunum Ileum ostium ileocaecale Ansae intestinales mesenterium Plicae circulares Kerkringi 6-8 mm Villi intestinales 0,3 -1 mm Glandulae intestinales – crypts of Lieberkuehn Duodenum Pars: superior (bulbus) descendens horizontalis ascendens 25 – 28 cm 5 10 8 L 2 5 L1 Flexura duodeni sup. Flexura duodeni inf. Flexura duodenojejunalis M. suspensorius duodeni (ligament of Treitz)  rich plicae circulares, villi  gll. duodenales Brunneri (alkalic secretion)  plica longitudinalis  papilla duodeni major et minor Differences in the duodenal mucosa Papilla duodeni major Vateri - dct. pancreaticus - dct. choledochus Papilla duodeni minor dct. pancr. access. Plica longitudinalis duodeni Connections to the12 and pancreas Localization against peritoneum: secondarily retro-peritonealy Jejunum from flexura duodenojej. (upper left) Ileum (lower right) 3/5 2/5 Mesenterium Attachment line = radix mesenterii 15 – 18 cm Ansae intestinales Differencies - lokalization - thickness of the wall - Number of folds - Arteries - Lymphoid tissue a. mesenterica sup. arkád y Plicae circulares Jejunum ø 3cm Aa. rectae A. mesent. sup. Arkády ø 2,5cm Ileum Foll. lymph. solitarii Foll. lymph. agregatti jejunum ileum Intestinum crassum 1,5-2m Caecum (+ appendix vermiformis) Colon ascendens transversum descendens sigmoideum Rectum Colon descendens et sigmoideum  Larger cross section  Grey color  taeniae coli, haustra,appendices epiploicae Characteristic features of the wall of the large intestine Taenia mesocolica Taenia omentalis Taenia libera Mucosa (no villi; plicae semilunares; lymphoid nodules) Submucose layer Musculature (longitudinal forms 3 taenias) Serosa Right illiac fossa Ostium ileocaecale - valva ileocaecalis -labium superius -labium inferius 6-8cm 5-10cm X Appendix vermiformis Ostium app. vermif. , valva ap.v. Lymph. tissue Mesoappendix Caecum Positio: pelvina retrocaecaecalis ileocaecalis laterocaecalis praecaecalis Positions lig. appendiculoovaricum Linea spinoumbilicalis dx. (line of Monro) Mc Burney´s point Linea bispinalis Lanz´s point Projection of appendix Colon ascendens fused with post. abd. wall flexura coli dextra (hepatica) Colon transversum To the left and up Hanging on mesocolon transversum flexura coli sinistra (lienalis) omentum majus, lig.gastrocolicum Colon descendens Became narrower fused with abd.wall Colon sigmoideum (crista iliaca → S2-3) mesosigmoiedeum. 15 50 22-30 30-40 Irigography DCBE 3 Rectum Canalis analis 1/4 S2-3 → anus small pelvis Ampula recti 3/4 Flexura - sacralis - perinealis ampula recti: 3 plicae transversae recti Plica t.r. media Kohlrausch canalis analis: 6-12 columnae anales valvulae anales sinus anales Mucosa Zona intermedia (pecten analis) Epithel: squamous not ceratinising Linea anocutanea Zona cutanea (anus) epithel squamous stritified ceratinising Zona haemorrhoidalis epithel: cylindrical plexus venosus rectalis int. Plexus venosus rectalis M. sphincter ani internus M. sphincter ani externus submucosa Dense connective tissue - PROLAPS ! Muscle layer internal circul. - m. sphincter ani int. External longitudinal Below diaphragma pelvis Striated m. - m. sphincter ani ext. Serosa / adventitia Anus  Opens in crena ani  pigmented skin  Thanks to sphincters closed  glandulae circumanales  Thicker hair Rectoscopy Illustrations, photographs, and radiographs were copied from: Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München: Urban & Schwarzenberg, 1993)