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10e stomach


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10e stomach

  1. 1. Zoltan Juhasz, M.D. 1
  2. 2. I. Stomach (ventriculus, gaster)J- shaped, intraperitoneal organ (lig. hepatogastricum, lig.gastrophrencicum, lig. phrencolienale, bursa omentalis)found mainly in epigastriumfunction: food storing-mixing, digestionparts: cardia, fundus (in left dome of diaphragm), incisura cardiaca,corpus (body), pylorus (outflow tract; antrum pyloricum canalispyloricus), anterior and posterior walls; greater and lesser curvature,incisura angularisblood supply: anastomosis along greater and lesser curvature lesser curvature: right gastric a.( from proper hepatic a.) --- left gastric a. (from celiac trunk) greater curvature: right gastroepiploic a. (from gastroduodenal a.) --- left gastroepiploic a. (from splenic a.) fundus: short gastric aa. (from splenic a. ; in gastrolienal lig.) veins: right and left gastric v. portal vein; short gastric veins, left gastroepiploic vein splenic vein; right gastroepiploic v. superior mesenteric v. 2
  3. 3. lymph drainage: upper two-third: gastric lymph nodes upper third of fundus and body: pancreatico-lienal lymph nodes lower third of body and greater curvature: pyloric lymph nodes, pancreatico-duodenal lymph nodesnerve supply: parasympathetic: vagus nerve (esophageal hiatus; the right branch supplies the posterior wall, the left branch the anterior wall of the stomach) sympathetic: greater splanchnic nerve (T6-T9) 3
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  5. 5. 1. esophagus 2. gastric fundus with air bubble 3. body of stomach 3a. lesser curvature 3b. greater curvature 4. incisura angularis 5. pars pylorica 6. ampulla duodeni 7. descendent part of duodenum 8. jejunum 9. left dome of diaphragm 10. left colic flexure (filled with air)AP enema X-ray 5
  6. 6. II. Small intestine (intestinum tenue)extends from pylorus to ileocecal junctionparts: duodenum jejunum ileummain function:absorbtion of nutrientsplicae circulares(circular folds) 6
  7. 7. 1. Duodenumthe first and shortest segment of small intestinesurround in C-shape the head of pancreasmost of duodenum is attached to the posterior abdominal wall by theperitoneum, partly retroperitonealparts: superior horizontal part (intraperitoneal, hepatoduodenal lig.; omental/epiploic foramen of Winslow; at the level of L1) descendent part (7-10 cm; major duodenal papilla of Vater- m.sphincter Oddi ; minor duodenal papilla; L1-L3) inferior horizontal part (6-8 cm; L3) ascendent part (5 cm; L3 L2; ligament of Treitz= m. suspensorius duodeni) duoudeno-jejunal flexure (L2)blood supply: gastroduodenal a. (from common hepatic a.) superior pancreatico-duodenal a.; inferior pancreatico- duodenal a. (from superior mesenteric a.) anastomosis between them venous drainage: superior mesenteric v. and splenic veinlymph drainage: pancreatico-duodenal,- pyloric, - mesenteric supp., -celiac lymph nodesnerve suppply: celiac plexus, superior mesenteric plexus (psy.: vagus n., sy.: greater and lessersplanchnic nerves) 7
  8. 8. 2. Jejunum and ileumaltogether 6-7 m in lengthmain part of ileum lies in the right lower quadrant of abdomen, the last part isin the pelvisintraperitoneal (mesenterium- root of mesenterium;at the level of L2,vessels, nerves,lymphatics, fat)blood supply : branches of superior mesenteric artery: ileal et jejunal aa.;superior mesenteric v. (with the splenic vein it forms the portal vein)lymph drainage: mesenteric and ileocolic lymph nodesnerve supply: vagus n., greater and lesser splanchnic nerves presynaptic sympathic fibers synape in celiac and inferior mesenteric ganglion presynaptic parasympathic fibers synapse in myenteric and submucous plexus visceral afferent sensory fibers- PAIN (distension of intestine wall -- colic:abdominal pain with spasm) 8
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  10. 10. Double contrast barium enema X-ray 10
  11. 11. III. Large intestine 1. Cecum; vermiform appendixa cecum is the first part of large intestine, continuous with theascendant colon; ileum ileocecal foramen (valve of Bauhin)in the right lower quadrant of abdominal cavity, in iliac fossacecum is covered with peritoneumvermiform appendix is a 6-10 cm long blind process, containinglymphoid tissue; peritoneal coverage: mesoappendixinflammation of vermiform appendix: appendicitis (McBurney s point:punctum maximum of pain: the outer and medial third border of a linebetween superior anterior iliac spine and umbillicus)blood supply: ileocolic a. ( branch of superior mesenteric a.) and itsbranch: appendicular arterylymph drainage: nodi lymphatici ileocolic and superior mesentericnerve supply: superior mesenteric plexus (sy. and psy. fibers) 11
  12. 12. Mc Burney s point 12
  13. 13. 2. Ascendent colonextends from cecum to right lobe of liver when it turnsleft: left colic flexureonly the anterior and lateral part is covered byperitoneumblood supply: right colic a., ileocolic a., middle colic a.(arcade anastomosis)- marginal a.; right colic v.,ileocolic v. superior mesenteric veinlymph drainage: paracolic-, epicolic-, ileocolic-,superior mesenteric lymph nodesinnervation: superior mesenteric plexus 13
  14. 14. 3.Transverse colon 45 cm in length, right colic flexure left colic flexure phrenicocolic lig., phrenicolienal lig., gastrocolic lig.intraperitoneal (transverse mesocolon)blood supply: middle colic a. , right and left colic arteries(anastomosis); superior mesenteric veinlymph drainage: superior mesenteric lymph nodesinnervation: superior mesenteric plexus (sympathetic,parasympathetic and visceral afferent fibers) 4. Descendent colonsecondarily retroperitoneal (peritoneal coverage anteriorly andlaterally)left colic flexure left iliac fossa, continuous with sigmoid colon 14
  15. 15. 4. Sigmoid colon40 cm in length, S-shapedextends from iliac fossa to S3 segment, where it joins rectum15 cm before anus taenias disappear, this is the rectosigmoidealjunctionintraperitoneal- mesosigmoidblood supply: left colic a. and sigmoid a. (from inferior mesenterica.); inferior mesenteric veinlymph drainage: intermedial colic and superior mesenteric lymphnodesnerve supply: sympathetic: aortic plexus, superior mesenteric plexus parasympathetic: pelvic splanchnical nerves- inferior hypogastric plexus a visceral afferent fibers run together with the autonomic fibers 15
  16. 16. slightly S-shapedsacral flexure, perineal flexureanal canal, rectal ampullaupper third intraperitoneal, middle thirdretroperitoneal, lower third infraperitoneal rectovesical/rectouterine pouch (cavity ofDouglas)in males the prostate and seminal vesicles, infemales the vagina can be palpated throughthe rectum (rectal digital examination) 16
  17. 17. blood supply: superior rectal a. (from inferior mesenteric a.),middle rectal a. (from internal iliac a.), inferior rectal a. (frominternal pudendal a.)- anastomosisvenous drainage: portosystemic anastomosis;v. superiorrectal v. portal vein; middle and inferior rectal v. inferiorvena cavaclinical importance: absorption of medicines from rectum ismore effective as it avoids the liver; rich submucosal venousplexuses- dilatation and protrusion: haemorrhoidal nodes lymph drainage: pararectal and sacral lymph nodeslymph nodes around aorta and IVCnerve supply: inferior hypogatric plexus/pelvic nn.,anus: m. sphincter ani internus (smooth muscle) andexternus (striated muscle), m. levator ani (striated) 17