1. Tongue-tie is characterized by an abnormally short lingual frenulum that can inhibit tongue movement and speech, and is corrected by surgically cutting the frenulum. 2. Ludwig's angina is a potentially life-threatening cellulitis of the floor of the mouth usually caused by a dental infection that causes swelling. 3. Carcinoma of the tongue most commonly involves the lateral margins of the front two-thirds of the tongue and can readily metastasize to lymph nodes on both sides.

1. ALIMENTARY TRACT
Clinical Anatomy

2. Tongue tie(Ankyloglossia)
It is characterized by an
abnormally short lingual
frenulum
It inhibits normal movements
of the tongue and may
interfere with normal speech
This can be corrected by
cutting the frenulum
surgically

3. Tongue-tie release—Frenotomy

4. Ludwig’s angina
It is a cellulitis of the
floor of the mouth
• Usually due to infection
from a carious molar
tooth, causing
inflammatory edema of
the floor of the mouth
• A potentially life-
threatening disease

5. Carcinoma of the tongue
Common site of carcinoma
It mostly involves lateral margins of
anterior two-thirds of the tongue
There is rich anastomosis across
the midline between the
lymphatics of the posterior one-
third of the tongue; therefore, a
cancer on one side readily
metastasizes to ipsilateral as well
as the contralateral lymph nodes.

6. Referred pain of cancer tongue
The patients with
cancer tongue often
complains of pain in
ear,
temporomandibular
joint, temporal fossa,
and/or lower teeth

7. Safety muscle of tongue
The genioglossus is called safety
muscle of the tongue
Two genioglossi are responsible for
the protrusion of the tongue
If these muscles are paralyzed, the
tongue will fall back into the
oropharynx and obstructthe air
passage causing choking and death

8. Clinical testing of the hypoglossal
nerve
The genioglossi are commonly used for clinical testing of
the hypoglossal nerve
The muscles of both sides acting together protrude the
tongue whereas single muscle deviate the tongue to the
opposite side
When patient is asked to protrude his tongue, the tongue
deviates to the paralyzed side

9. Clinical testing of the hypoglossal
nerve

10. Piriform fossae
The piriform fossae are dangerous sites
for perforation by an endoscope
The ingested foreign bodies (for
example, fish bones, safety pins) are
sometimes lodged into the piriform fossa
The removal of foreign bodies may
damage the internal laryngeal nerve
leading to anesthesia in the supraglottic
part of the larynx and subsequent loss of
protective cough reflex

11. Waldeyer’s ring

12. Tonsillitis
Inflammation of tonsils
The tonsils are the frequent sites of
acute infection especially in school-
going children
It may affect adults also
It is mostly seen in viral infection

13. Pharyngeal Pouch
The mucosa and
submucosa of the
pharynx may bulge
through weak area
,Killian,s dehiscence
,to form a
pharyngeal pouch
or diverticulum

14. Gag reflex
It is a protective reflex
It is a contraction of the back of
the throat triggered by an object
touching the roof of mouth, the
back of tongue, the area around
tonsils, or the back of throat

15. Cleft palate
The defective
fusion of
various
segments of
the palate gives
rise to clefts in
the palate

16. Esophageal varices

17. Esophageal varices
Esophageal varices are abnormal, enlarged veins in the esophagus
The lower end of the esophagus is one of the important sites of
portocaval anastomosis
In portal hypertension (e.g., due to cirrhosis of the liver), the
portocaval anastomotic channels open and become dilated and
tortuous
Their rupture may cause severe and fatal hematemesis

18. Achalasia cardia

19. Barrett’s oesophagus
This is a pre-
malignant condition
in which the
squamous lining of
the lower oesophagus
is replaced by
columnar mucosa
with areas of
metaplasia.

20. Gastric carcinoma (gastric cancer)
It commonly occurs in the region
of pyloric antrum along the
greater curvature of the
stomach
The gastric cancer spreads by
lymph vessels to the left
supraclavicular lymph nodes
The enlarged and palpable left
supraclavicular node (Virchow’s
node) may be the first sign of
gastric cancer (Troisier’s sign)

21. A surgical procedure of
cutting the vagus nerves
It is done to cure the
chronic duodenal ulcers
Truncal vagotomy:
Selective vagotomy:
Vagotomy

22. Gastric pain
It is usually
referred to the
epigastric region
because the
stomach is
supplied by T6–
T10 spinal
segments

23. Radiology of the stomach
A plain erect film
of the
abdomenreveals a
bubble of air
below the left
diaphragm; this is
gas in the
stomach fundus.

24. Gastroscopy
The mucosa of
the air-inflated
stomach can be
inspected in the
living subject
through the
gastroscope.

25. Duodenal ulcer
The duodenal ulcers
commonly occur in
the first part of the
duodenum
Because it is supplied
by a series of end
arteries and receives
the acidic chyme
from the stomach

26. Duodenal cap( bulb)
In barium meal X-ray
of abdomen, the first
part of the duodenum
presents a triangular
shadow having a well-
demarcated base and
less distinct apex
called duodenal cap or
bulb

27. Duodenal cap( bulb)
When duodenal
ulcer is present in
the first part, a small
fleck of barium is
found filling the
ulcer crater and the
duodenal cap is said
to be deformed

28. Duodenal injuries
The third part of the
duodenum is most
vulnerable to external
injury
It gets crushed between
the vertebral column and
the anterior abdominal
wall following violence Duodenal hematoma.:This is a crushing
injury from compression of the anterior
abdominal wall against the spine.

29. Duodenal diverticula
They are congenital
All most always occur
in the medial wall of
the second part of the
duodenum

30. Annular pancreas
Developmental
anomaly in
which a ring of
pancreatic tissue
encircles the
second part of
the duodenum

31. Appendicitis
The inflammation of the appendix
The initial pain of appendicitis is the
referred pain
It is felt in the umbilical region because
both have same segmental nerve supply
(i.e., T10 spinal segment )
Gradually the pain is localized in the right
iliac fossa
It is due to involvement of local parietal
peritoneum

32. McBurney’s point
It is marked on the surface by
a point at the junction of
medial two-third and lateral
one-third of a line extending
from the umbilicus to the right
anterior superior iliac spine
On palpation maximum
tenderness is elicited at
McBurney’s point in
appendicitis

33. Appendectomy
The surgical removal of
the appendix
It’s a common emergency
surgery that’s performed
to treat appendicitis, an
inflammatory condition
of the appendix

34. Examination of the interior of
colon
Barium enema is used for
visualizing the interior of the
colon
The typical pattern of the
colon due to the presence of
sacculations is clearly seen

35. Congenital
megacolon/Hirschsprung disease
It occurs when neural crest cells fail to
migrate and form the myenteric
plexus(parasympathetic ganglia) in the
sigmoid colon and rectum during
embryonic development
Absence of peristalsis
The normal proximal colon becomes
grossly dilated due to the fecal retention
causing abdominal distension

36. Cancer (carcinoma) of colon
Cancer of colon (actually large
intestine) is a leading cause of
death in the Western world
It is slow growing tumor and
causes constriction of the colon
The growth is restricted to the wall
of colon for a considerable time
before it spreads by lymphatics
If diagnosed early, hemicolectomy
(partial resection of the colon) is
done to treat the patient

37. Diverticulosis
A common clinical condition of
the colon
It consists of the herniation of the
lining mucosa through the circular
muscle between the teniae coli
The herniation occurs where the
circular muscle coat is the weakest

38. Volvulus
It is a clinical condition, in
which a portion of gut
rotates
(clockwise/anticlockwise)
on the axis of its mesentery
It usually occurs due to
adhesion of antimesenteric
border of the gut to the
parietes or any other viscera

39. Intussusception
It is a clinical condition in
which a proximal segment
of the bowel invaginates
into the lumen of an
adjoining distal segment
This may cut off the blood
supply to the bowel and
cause gangrene

40. Rectum
The lymphatics of the rectum are mostly arranged
longitudinally in contrast to the lymphatics of
most of the small and large intestines, where they
are arranged transversely around the gut
Therefore, when the carcinoma of the rectum
spreads along lymphatics it does not cause rectal
obstruction unlike the rest of the gut

41. Prolapse of rectum
It is the protrusion of the rectum through the anus
The prolapse may be incomplete or complete

42. Rectal examination
Rectum can be palpated by the
finger passed per rectum in the
normal patient
The following structures can be
palpated:
both sexes — the anorectal ring
(see above), coccyx and sacrum,
ischiorectal fossae, ischial spines

43. Rectal examination
In both sexes : the anorectal ring
(see above), coccyx and sacrum,
ischiorectal fossae, ischial spines
In male :prostate, rarely the healthy
seminal vesicles
In female: perineal body, cervix,
occasionally the ovaries.
Abnormalities which can be detected

44. Hemorrhoids (or piles)
These are variceal dilatations of the
submucosal anal and perianal
venous plexuses
They are classified into
two types
Internal hemorrhoids (or true piles)
External hemorrhoids (or false piles)

45. Internal hemorrhoids (or true piles)
These are the saccular
dilatations of the tributaries
of the superior rectal
(hemorrhoidal) vein above
the pectinate line in portal
obstruction
The internal hemorrhoids
may be primary or
secondary

46. Internal hemorrhoids (or true piles)
The primary piles are formed due to dilatations
of main tributaries/radicles of the superior rectal
vein which lie in the anal columns
which occupy the left lateral, right posterior,
and right anterior positions
The dilatations of radicles of superior rectal
vein in other positions are termed secondary
piles
The location of primary pilescorresponds to the
3 o’clock, 7 o’clock, and 11 o’clock positions
of the anal wall

47. External hemorrhoids (or false
piles)
These are dilatations of the
tributaries of inferior rectal
vein below the pectinate line
They are covered by the
mucous membrane of the
lower half of the canal
They are very painful and do
not bleed on straining during
defecation

48. Perianal abscesses
These may be localized beneath the
anal mucosa (submucous), be
beneath perianal skin
(subcutaneous)
May occupy the ischiorectal (-anal)
fossa
Occasionally, abscesses lie in the
pelvirectal space above levator ani

49. Fissure in anorectal canal
An ulcer in the anal canal below
the level of the pectinate line,
mostly in midline and posteriorly
It is caused by rupture of one of
the anal valves (valves of
Morgagni) by the passage of hard
fecal mass
The common cause is trauma due
to passage of hard stools, followed
by chronic infection

50. Fistula in anorectal canal
An abnormal hollow tract or
cavity that is lined with
granulation tissue and that
connects a primary opening inside
the anal canal to a secondary
opening in the perianal skin
It is caused by the rupture of an
abscess around the canal

51. Any questions ?

53. Splenomegaly
The enlargement of the
spleen (splenomegaly)
The common causes of
massive splenomegaly are:
(a) malaria, (b) cirrhosis of
liver, (c) chronic myeloid
leukemia, and (d) kala-azar

54. Palpation of the spleen
The normal spleen is not palpable
It can be mapped out by percussion
When it is enlarged more than
double of its size, it becomes
palpable at the left costal margin
during deep inspiration

55. Splenectomy
Surgical removal of the spleen
Performed:-
when the spleen is ruptured or
inadvertently nicked at operation
in the treatment of certain blood
diseases

56. Kehr's sign
Kehr's sign is the occurrence of acute
pain in the tip of the shoulder due to
the presence of blood or other
irritants in the peritoneal cavity when
a person is lying down and the legs
are elevated
Kehr's sign in the left shoulder is
considered a classic symptom of a
ruptured spleen