THE ORAL CAVITY

THE ORAL CAVITY

WALL OF ABDOMEN (ANTERIOR) The paraumbilical vein drains into the portal vein and then through the liver. This is an important clinical connection.

THE ABDOMINAL VISCERA

The small intestine has three anatomical divisions: the duodenum, the jejunum, and the ileum. The small intestine (7 m.) extends from the pylorus to the ileocolic junction, where it joins the large intestine. The duodenum is described as having four parts: 1. Part one, superior part (SD) 2. Part two, descending part (DD) 3. Part three, horizontal part (HD) 4. part four, ascending part (AD) The fourth part of the duodenum terminates at the duodenojejunal flexure (DJF) with the jejunum. THE DUODENUM (ANTERIOR VIEW)

THE DUODENUM (POSTERIOR VIEW) The second part of the duodenum receives the bile duct, the pancreatic duct, and the accessory pancreatic duct.

THE SMALL & LARGE INTESTINES

JEJUNUM & ILEUM The jejunum and ileum is slung from the posterior abdominal wall by the mesentery of the small intestines and, therefore, is extremely mobile. The mesentery of the small intestine arises from the root of the mesentery which extends from the duodenojejunal flexure to the ileocecal junction. The root of the mesentery is that border attached to the abdominal wall. The root is about 15 cm.long and is directed obliquely downward and to the right, from the duodenojejunal flexure to the level of the right sacro-iliac joint.

THE SUPERIOR MESENTERIC ARTERY The ileum and jejunum are supplied by the superior mesenteric artery and its intestinal branches. The branches are rather special in that small arcades are formed and from the arcades, the straight vessels, vasa recta arise and supply the intestine. These straight One way to tell the ileum from the jejunum, other than by general location, is that there are more layers of arcades before the vasa recta are given off, in the ileum.

THE INTESTINAL WALL General structure of intestinal wall. Mucosa - Epithelium - Lamina (Tunica) propria - Muscularis mucosae Submucosa - Dense connective tisue Muscularis - Circular layer - Longitudinal layer Serosa - Connective tissue + mesothalium Plicae circulares (Kerkring) = folds of mucosa + submucosa Vili = fingelike projection of mucosa

INTESTINAL VILLI The intestinal vili contains bloodvessels, lymphatics (lacteals), and nerves (autonomic). The covering epithelium is a simple columnar epithelium with goblet ceels.

PLICA CIRCULARES & VILLI

THE PORTAL CIRCULATION (VENOUS DRAINAGE OF THE VISCERA) The portal vein is usually described as being formed by the splenic and superior mesenteric veins. The inferior mesenteric vein then joins the splenic vein. However, there are variations to this pattern and might exist. Two of these are that the inferior mesenteric vein may join at the junction of the splenic with the superior mesenteric or the inferior mesenteric veins may join the superior mesenteric vein before it merges with the splenic.

THE LARGE INTESTINE The large intestine extends from the ileocecal junction to the anus and is about 1.5m long. On the surface, you can identify bands of longitudinal muscle fibers called taeniae coli, each about 5mm wide. There are three bands and they start at the base of the appendix and extend from the cecum to the rectum. Along the sides of the taeniae, you will find tags of peritoneum filled with fat, called epiploic appendages (or appendices epiploicae). The sacculations, called haustra, are characteristic features of the large intestine, and distinguish it from the rest of the intestinal tract.

MICROSCOPIC ANATOMY OF COLON The mucosa is relatively smooth as compared with that of the small intestine. There are no villi. Tubular pits or glands are present. Solitary nodules of lymphatic tissue are numerous. The outer longitudinal muscle layer is massed in three thick bands, the taeniae coli. The serosa contains lobules of fat which form pendulous projections, called appendices epiploicae.

THE ILEOCECAL JUNCTION The cecum is about 6cm long and is a blind cul-de-sac which lies in the right iliac fossa. It is the part of the colon below the opening of the ileum into the colon. Hanging off the cecum is the vermiform appendix which opens into the cecum about 2cm below the ileocecal opening. The average length of the appendix is about 10cm and may lie in different positions. It has its own mesentery called the mesoappendix which carries the appendicular artery. If the cecum is opened, you can identify the opening of the ileum into the cecum. This opening is surrounded by thickened muscle which forms the iliocolic valve.

BLOOD SUPPLY TO THE LARGE INTESTINE The colon is supplied by branches of the superior mesenteric and inferior mesenteric arteries. The inferior mesenteric artery is distributed from the left part of the transverse colon to the rectum.

THE ARTERIAL SUPPLY

BLOOD SUPPLY TO THE VISCERA The three anterior branches of the abdominal aorta include: 1. Celiac artery 2. Superior mesenteric artery 3. Inferior mesenteric artery These arteries have its own area of supply; 1. Foregut celiac artery 2. Midgut superior mesenteric art. 3. Hindgut inferior mesenteric art.

THE RECTUM The rectum is the continuation of the sigmoid colon and at the point of their junction, the rectum becomes covered by peritoneum only on its anterior surface, and therefore becomes retroperitoneal. The rectum terminates approximately at the attachment of the levator ani to its borders. Also at this point, is the pectinate line which, anatomically, is the anorectal junction. The lining of the anal canal is continuous with the skin at the white line of Hilton (or intersphincteric line).

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