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2nd lecture git


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2nd lecture git

  1. 1. Oropharyngeal isthmus (isthmus faucium) – soft palate, palatoglossal andpalatopharyngeal arches, the root of the tongue. Approximation of the arches, to shut off themouth from the oropharynx, is essential to deglutition.Palatine tonsil (tonsilla palatina)sinus tonsillarisplica triangularisfossa supratonsillariscryptae tonsillarestonsillitis – tonsillar pegsparatonsillar vein – venous hemorragetonsillectomyMuscles of the tongueaponeurosis linguae, septum linguae, hypoglossal nerve (CN XII).Extrinsic muscles:M. genioglossusM. styloglossusM. palatoglossusM. hyoglossus – (canalis paralingualis contains the lingual artery)Intrinsic muscles:Superior longitudinal muscle (m. longitudinalis superior)Inferior longitudinal musle (m. longitudinalis inferior)Transverse muscle (m. transversus)Vertical muscle (m. verticalisMuscles of the soft palateM. tensor veli palatini - trigeminal nerve (IX., X.)M. levator veli palatini - plexus pharyngeus (IX., X.)Musculus uvulae - plexus pharyngeus (IX., X.)M. palatoglossus - plexus pharyngeus (IX., X.)M. palatopharyngeus plexus pharyngeus (IX., X.)Movements of the palate are essential to swallowing, blowing and speech; all requiresvariable degrees of closure of the nasopharynx. In deglutition closure prevents regurgitationinto the nasopharynx. During closure levatores veli palatini pull the soft palate up and backtowards the posterior pharyngeal wall while simultaneously the palatopharyngeal muscleraises the wall.PHARYNXfornix pharyngispharyngeal recesscavum pharyngisfascia pharyngobasilarisPars nasalis pharyngis (nasopharynx)
  2. 2. choanaeostium pharyngeum tubae auditivae - torus tubarius - plica salpingopharyngea, plica salpingopalatina, torus levatoriustonsilla pharyngea - fornix pharyngistonsilla tubariaWaldeyer’s lympfoepithelial ringPars oralis pharyngis (oropharynx) - isthmus fauciumPars laryngea pharyngis (laryngopharynx) – aditus laryngis - epiglottis, aryepiglottic folds – recessus piriformis – plica n. laryngeiMuscles of the pharynxConstrictors - raphe pharyngisM. constrictor pharyngis superior:1. Pars pterygopharyngea –lamina medialis proc. pterygoidei2. Pars buccopharyngea –raphe pterygomandibularis3. Pars mylopharyngea –linea mylohyoidea mandibulae4. Pars glossopharyngea – transverse muscle of the tongueM. constrictor pharyngis medius:1. Pars chondropharyngea –cornu minus ossis hyoidei2. Pars ceratopharyngea - cornu majus ossis hyoideiM. constrictor pharyngis inferior:1. Pars thyropharyngea –linea obliqua of the thyroid cartilage2. Pars cricopharyngea – cricoid cartilageLevators:M. stylopharyngeus – from the processus styloideus caudally and medially - the fissurebetween the superior and middle constrictors.M. palatopharyngeusM. salpingopharyngeus – from the cartilaginous part of the auditory tubeThe pharynx actively participates in swallowing, respiration and phonation. Duringswallowing the muscles of the soft palate open the auditory tube to ventilate the tympaniccavity.Mechanism of the deglutitionThe first stage of the swallowing is voluntary: the anterior part of the tonge is raised andpressed against the hard palate. A bolus is pushed dorsaly. The hyoid bone is is moved up andforwards by the suprahyoid muscles. The root of the tonge is drawn up and back andpalatoglossal arches are approximated, pushing the bolus through the isthmus of the faucesinto the oropharynx.The second stage is involuntary. The soft palate is elevated, tightened and firmlyapproximated to the posterior pharyngeal wall (by the upper pharyngeal constrictor). Then the
  3. 3. larynx and pharynx is drawn up (stylopharyngeus, palatopharyngeus, thyrohyoid muscles).Simultaneously, the aryepiglottic folds are approximated and epiglottis bends back onto thelaryngeal inlet excluding the bolus from the larynx. The bolus slips into the lowest part of thepharynx.The last stage is the expulsion of the bolus into the oesophagus, by the inferior constrictors.OESOPHAGUS1) Pars cervicalis2) Pars thoracicapars retrotrachealispars retropericardiaca3) Pars abdominalis - cardia - gastrooesophageal junction3 physiological narrowingshiatus oesophageusadventitia, serosaoesophagoscopy, oesophagographySTOMACH (GASTER, VENTRICULUS)regio hypochondriaca sinistraJ-shaped stomach, steer horn (transverse type)cardiapars cardiacafundus (fornix) ventriculi - stomach bubbleincisura cardiacacorpus ventriculi - canalis gastricuspars pylorica - antrum pyloricum, canalis pyloricuspylorus - ostium pyloricumparies anteriorparies posteriorcurvatura minor - incisura angulariscurvatura majorFunctionally:Pars digestoria (digestive segment) - fundus and canalis gastricus.Pars egestoria (evacuating segment) - gastric sinus (antrum) and canalis pyloricusPlicae gastricae– sulcus salivariusMucinous glands – mucusTubulous glands - succus gastricusAreae gastricae - foveolae gastricaeMusculature – fibrae obliquae - stratum circulare - m. sphincter pylori - stratum longitudinaleAfter the stomach is filled the musculature contracts and is in the rest (peristole), the mucosaadheres to the content (20 min). Then rhythmical contractions (peristalsis) begin. Peristalticwaves start in the cardia each 15 -30 seconds and get to the pylorus in 60 seconds. Four waves
  4. 4. may be seen together at the X-ray picture. Peristalsis serves for the mixing of the content tothe pulpy chyme that in small portions is emptied to the duodenum.Omentum minus – lig. phrenicogastricum, hepatogastricum, hepatoduodenaleOmentum majus - lig. gastrocolicum, lig. gastrolienaleINTESTINUMIntestinum tenueansae intestinalesDuodenumpars superior - bulbus duodeniflexura duodeni descendens duodeniflexura duodeni horizontalispars ascendensflexura duodenojejunalisplicae circulares Kerkringivilli intestinalescrypts of Lieberkuhn – glandulae intestinalesglandulae duodenales Brunneriplica longitudinalis duodeni - papilla duodeni major Vateri - papilla duodeni minorJejunum and ileum - jejunoileumJEJUNUM ILEUMupper left part of the lower right part of theinframesocolic space inframesocolic spacewider (3-4 cm) narrower (2-3 cm)more plicae circulares fewer plicae circulares1-2 arcades 2-3 arcadesfolliculi lymph. solitarii folliculi lymph. aggregatimesenteriumostium ileocaecale - valva ileocaecalis