Clinical anatomy of the GIT.pptx

Dr. NDAYISABA CORNEILLE
CEO of CHG
MBChB,DCM,BCSIT,CCNA
Supported BY
CLINICAL ANATOMY
OF THE GIT

ESOPHAGUS
• The esophagus is a muscular
tube that connects the pharynx
to the stomach.
• It begins in the neck where it is
continuous with the
laryngopharynx at the
pharyngo-esophageal junction.
• The esophagus consists of
striated (voluntary) muscle in its
upper third, smooth
(involuntary) muscle in its lower
third, and a mixture of striated
and smooth muscle in between.
Dr Ndayisaba Corneille

APPLIED ANATOMY: Esophageal Varices:
• This results in cases of portal
hypertension due to backward flow of
blood into the systemic veins
• This results in mark dilation of the
lower esophageal veins.
• In cases of increased pressure these
varicosed veins will burst and this will
lead to hematemesis and even fatal
hemorrhage.

Achalasia Cardia:
• A rare disorder making it difficult for
food and liquid to pass into the
stomach.
• There is neuromuscular incoordination of the esophageal
musculature as a result the difficulty in the passage of food
through the esophagus this condition is known as dysphagia
• It may be caused by an abnormal
immune system response.
• Symptoms include a backflow of
food in the throat (regurgitation),
chest pain and weight loss.
• there would be accumulation of food especially at the lower
part of the esophagus (abdominal part) and it will result in
mark dilatation of the esophagus forming the achalasia cardia.

Esophagitis
1. The abdominal part of esophagus is
most prone to esophageal carcinoma,
peptic ulceration and inflammation
this is due to regurgitation of the
gastric acid. This is mostly found in
patients regurgitative esophagitis.
2. Referred pain due to esophagitis is
felt at the precordium and epigastric
region.

Sliding hiatus hernia.
• Sometimes the esophagus ends
above the diaphragm as a result
of this a hour glass stomach is
formed which will lead to a
sliding hiatus hernia is formed.
• In most cases, a small hiatal
hernia doesn't cause problems.
• But a large hiatal hernia can
allow food and acid to go up
into the esophagus, leading to
heartburn.
• a very large hiatal hernia
sometimes requires surgery.

The stomach
• The stomach is a
dilated part of the
alimentary canal
between the esophagus
and the small intestine.
• It is a muscular sac.
• It is a J-shaped.

APPLIED ANATOMY of the Stomach
• Vagotomy
• This is the process of cutting up the vagus nerve so as to abolish the
neurogenic gastric juice supply of the stomach.
• The vagus nerves play a dominant role in the stimulation of
gastric secretion. The basal or continuous secretion of gastric juice
is almost entirely caused by tonic impulses in the vagus nerves.
• Vagotomy also makes the stomach to becomes flaccid and this will
result to difficulty in the passage of food into the duodenum since
the action of the pyloric sphincter is compromised.
• There are two types of vagotomy.

Total or complete vagotomy:
• Where by the vagus nerve is totally
cut off as a result of this the
sphincteric action is compromised
and passage of food is disrupted but
to save the situation some
procedures are carried out to help in
the passage of food into the small
intestine.
• One of such procedures is the
pyloroplasty where a tube is forced
into the pyloric orifice thereby
making the sphincteric action
ineffective and through the tube food
will gradually enter into the
duodenum.

SELECTIVE VAGOTOMY:

Gastrectomy
• Gastrectomy is surgery to remove
part or all of the stomach. If only
part of the stomach is removed, it is
called partial gastrectomy. If the
whole stomach is removed, it is called
total gastrectomy.
• About half of the patients subjected to
total gastrectomy experience weight
loss.
• Malabsorption, particularly fat
malabsorption, is a common feature
after total gastrectomy. This may be
due to shortened intestinal transit
time, but is less often due to diarrhea
or pancreatic exocrine insufficiency.

Gastritis
• Gastritis: This is caused vagal
stimulation which leads to high
release of secretin which
stimulates high acid secretion.
Drugs like aspirin and others
steroids can also lead to gastritis.
• Gastritis pains are most times
referred to the epigastric region
(5th to 7th dermatome)

Peptic ulceration
• Peptic ulcers occur when
acid in the digestive tract eats
away at the inner surface of
the stomach or small intestine
• Peptic ulceration
usually occurs at the
lesser curvature as a
result of presence of
the gastric canals.

Stomach Ulcer
• Stomach ulcers, also known as
gastric ulcers, are sores that
develop on the lining of the
stomach
• Stomach ulcers are usually
caused by Helicobacter pylori
(H. pylori) bacteria or non-
steroidal anti-inflammatory
drugs (NSAIDs).
• These can break down the
stomach's defense against the
acid it produces to digest food.
The stomach lining then becomes
damaged causing an ulcer to form

Stomach ulcer ………………
• when the ulceration becomes perforated it will result
to peritonitis and the pain in the situation will be
localized at the point of irritation.
• Stomach ulcer pain usually
begins in the upper middle part
of the abdomen, above the
umbilicus and below the
sternum.
• The pain may feel like burning
sensation that may go through
to the back. The onset of the
pain may occur several hours
after a meal when the stomach
is empty.

PANCREAS
• Soft, lobulated
elongated gland with
both exocrine and
endocrine functions
• Exocrine –pancreatic
juice
• Endocrine-insulin

Annular pancreas:
• Developmental anomaly
where ring of pancreatic
tissue surrounds and
obstruct duodenum

LARGE INTESTINE
The large intestine constitutes the terminal part of
the digestive system.
It is divided into three main sections: cecum
including the
he primary function of the large intestine is the
 secretion is mucus, acts as a lubricant during the
transport of the intestinal contents.

The vermiform Appendix/Abdominal
Tonsil
• Worm like narrow tubular diverticulum
• Arises from posteromedial wall of the
Caecum, 2 cm below the ileo-caecal
junction
• Suspended by a peritoneal fold –
mesoappendix
• It is a vestigial organ
• Devoid of taenia coli, sacculations,
appendices epiploicae
• 2 -20 cm in length. ( average -9 cm)

Base of appendix Mc. Burney’s
point maximum tenderness
inflammation of appendix
Spinoumbilical line

The rectum
• The rectum is part of the GIT that lies
between the sigmoid colon and anal
canal.
• it is about 12cm in length
• It extends from the point where the
sigmoid colon looses its mesentery which
is anterior to the level to 3rd sacral
vertebrae and terminates at the point
where its muscular coat is replaced by
internal anal sphincter at the anorectal
junction, just as it passes through the
pelvic floor behind the perineal body.

DISTINGUISHING FEATURES
• Absence of plicae circularis.
• There is absence of appendix epiplocae.
• Absence of taenia coli, the taenia coli of the large
intestine on getting to the rectum spreads out in a
complete longitudinal muscular coat which is
condensed anteriorly and posteriorly as the anterior
and posterior band. In between these bands the
longitudinal coat muscle is thin.
• There is absence of mesenteric attachment as in other
parts of the large intestine.
• The rectum also presents sets of folds known as pilcae
transversalis which also disappears as the rectum
distends.
• The rectum presents a dilated lower part known as the
rectal ampulla which normally stores the resting feaces
and flatus.

APPLIED ANATOMY: Digital examination of the Rectum
• During digital
examination or
sigmoidoscopy, the
patient is placed knee-
chest position, lateral
prone position, the
modified lithotomy
position, or the patient
can bent over on a
special table where the
body is bent at an
angle of 90O
• These positions are
mainly to draw the
abdominal viscera
upward into the upper
abdominal cavity.
PR - Per rectal examination

Rectal varies
• Rectal varies occur because of
portosystemic anastomosis which occurs
between the superior rectal vein which
is a tributary of the IMV (Portal) and
middle rectal vein a systemic vein,
• Portal obstruction will lead to pressure
on the superior rectal vein as a result of
this, there will be shunting of blood into
middle rectal vein which will result to
increased blood flow through the
communicating venous channels which
will become varicose giving rise to Rectal
Hemorrhoids.

Cancer of the rectum:
• The rectum is most prone to carcinoma
and when it occurs it could spread
extensive through lymphatic and venous
channels.
• It can affect the liver through the portal
system,
• it can affect the uterus and the ovary in
females, it can also involve the prostate,
the urinary bladder in males through
lymphatic channels,
• when the cancer occurs posteriorly it
could involve the sacral plexus thereby
causing pain across the lower limb and
pain around the perineum.

Anal canal
Terminal part of alimentary tract
it begins at ano-rectal junction
Rectal ampulla suddenly
narrows at ano-rectal junction
2-3 cms infront and slightly
below tip of coccyx
From ano-rectal junction the
canal passes Downwards &
backwards through
Pelvic diaphragm

INTERIOR OF ANAL CANAL
Divided by pectineal line & Hilton’s line into 3 areas
1. Upper (15 mm)
2. Intermediate (15 mm)
3. Lower (8 mm)
(Anal verge)
Pectinate / dentate line
Hilton’s line

ANORECTAL DISEASES
• Hemorrhoids
• Ischiorectal Abscess
• Fistula in ano
• Fissure in ano

Haemorrhoids
haimorrhoides
haima=blood rhoos=flowing
bleeding

in anal canal
which may or may not bleed
Piles
pila (a ball)
swelling

Pathogenesis
• Various theories are :
1. Portal hypertension and varicose veins
2. Upright posture of human beings
3. Erosion and weakening of wall of veins due
to infection secondary to trauma
5. Hard faecal matter obstructing venous return
6. Raised anal canal resting pressure

External hemorrhoid Internal hemorrhoid
Below dentate line Above dentate line
Varicosities of veins
draining
inferior rectal vein
Varicosities of veins
draining
superior rectal vein
Lined by
Stratified squamous
epithelium
Lined by
columnar epithelium
Painful Pain insensitive
Prone to thrombosis if vein
ruptures
(Thrombosed pile)
May prolapse outside anal
canal
(prolapsed hemorrhoid)

HEMORRHOIDAL DISEASE
A
P
L
R
Primary Locations
3-7-11 o’clock positons
(Left Lateral, Right Anterior
and Right Posterior)
Right
Posterior
Right
Anterior
Left Lateral
3 MAJOR PILES

Anorectal Abscess and Fistula
• Anal fistula?
This is an abnormal
communication between anal
canal &skin
Approx. 50% of anal abscess occur
secondary to anal fistula.
Abscess is the acute sign.
• Anorectal abscess is presented
as an
Inflamed and tender perianal
swelling

Anal Fissure
• Anal fissure
Linear ulcer (anal canal) dentate to anus
• Symptoms of anal fissure
Bleeding / anal pain
• Physical findings
Split in anal canal, posterior midline,
sentinel pile, Digital Rectal Examination
(DRE)is extremely painful

Sentinal pile is a tag formed by a ruptured anal valve

Sentinel skin tag Anal fissure ()
CLINICAL CASE:
A 34 year old white female presents to your office experiencing painful "hemorrhoids" for 4 weeks. She states
that the pain is associated with her bowel movements and is severe. She denies any blood per rectum.
Anal fissure
CASE STUDY

END
THANKS FOR LISTENING
By
DR NDAYISABA CORNEILLE
MBChB,DCM,BCSIT,CCNA
Contact us:
amentalhealths@gmail.com/
ndayicoll@gmail.com
whatsaps :+256772497591
/+250788958241

Clinical anatomy of the GIT.pptx

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Clinical anatomy of the GIT.pptx