GASTROINTESTINAL SYSTEM
Ahmad Azwar Habibi
Lab.Anatomi FKIK UINSH
TOPICS
Competencies of GI system SKDI
Overview:
Gastrointestinal tract
Accessory organ
Diare
Nyeri perut
Perut kembung
Muntah
Sulit BAB/sembelit
Sakit dan sulit menelan
Mulut kering
Bau mulut
Sakit gigi
Sariawan
Bibir pecah-pecah
Sendawa
Cegukan
Nyeri ulu hati
Nyeri sesudah makan
Kelainan tinja
Ambein
Nyeri saat BAB
Gatal daerah anus
Perdarahan saat BAB
Nyeri daerah anus
Muntah darah
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OVERVIEW :
GASTROINTESTINAL SYSTEM
Gastrointestinal
Tract (alimentary
canal/digestive tube)
Accessory digestive
organs
Teeth, tongue.
Digestive glands:
salivary glands, liver,
gallbladder,
pancreas.
GI SYSTEM ABDOMEN
Boundaries:
Superior: xyphoid process & costal margin
Posterior: vertebral column
Inferior: upper parts of the pelvic bones.
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ORGANIZATION OF
THE RECTUS SHEATH
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ABDOMINAL WALL
INGUINAL REGION
Inguinal ligament
Inguinal canal
Structures passing
through the canal
(male & female)
Superficial inguinal
ring (annulus
inguinalis medial/
superficial)
Deep inguinal ring
(annulus inguinalis
lateral /profundus)
Conjoint tendon
Inguinal hernias:
direct & inderect
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PERITONEUM
Peritoneal folds:
Omenta :the folds suspending
the stomach
Mesenteries: the folds
suspending the small and large
intestines
Ligament
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PERITONEUM
Connected by omental
foramen (epiploic foramen of
Winslow)
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Midclavicular
plane
Subcostal plane
Transtubercular
plane
(a
)
(b)
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Right/left to frenulum of
tongue opening of
submandibular glands
Opposite to the upper M2
opening of the parotid
duct
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(2) PHARYNX
Lies behind oral
cavity proper
Divide into 3 parts:
Nasopharynx:
posterior to
choane
Oropharynx:
posterior to oral
cavity
Laryngopharynx:
posterior to larynx
Open to esophagus at
the level C VI
vertebrae.
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(3) ESOPHAGUS
Muscular tube, + 25 cm
Begins as a continuation of the
pharynx, at the level of the
vertebra CVI.
Divided into 3 part : cervical,
thoracic, abdominal syntopy
with other organs?
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(4) STOMACH
J - shaped
Regions :
Cardia : opening of oesophagus
into the stomach)
Fundus (dome shape): area
above the cardiac opening
(orificium cardiaca)
Body of stomach (corpus)
Pylorus
Projection of region ?
Curvatura major - curvatura minor
Incisura cardiaca - incisura
angularis
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DUODENUM
C-shaped
Rounding the head of the pancreas
Retroperitoneal, except for its
beginning
Location: epigastric & umbilical region
Connected to the liver by
hepatodudenal lig.
Part of duodenum
Flexures:
Superior duodenal flexure
Inferior duodenal flexure
Duodenojejunal flexure: surounded by
a fold of peritoneum containing muscle
fibers ligament of Treitz
Or windows
Mesentery of jejunum
Mesentery of ileum
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Jejunum
Ileum
Location
Diameter
2 4 cm
2 3 cm
Lumen
Wider
Narrower
Walls
Windows present
No windows
Arterial arcade, 1 or 2
absent
present
Mesentery
Lymphoid nodules
(Peyers Patches)
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Cecum
Colon
Rectum
Anus
Appendix
epiploicae
Haustr
a
Semilunar fold
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APPENDIX
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COLON
Colon consist of:
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
At the junction between:
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RECTUM
Peritoneal relations
Upper 1/3 of rectum is covered
by peritoneum
Middle 1/3 of rectum, is
covered only in anterior part.
The lower 1/3 of rectum is
devoid of peritoneum, and
dilated to form the ampulla
(ampulla recti). It lies posterior
to Douglas pouch (rectouterine
pouch) in females; and
rectovesical pouch in male.
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ANAL CANAL
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ACCESSORIES
DIGESTIVE ORGANS
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(1) TEETH
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(2) TONGUE
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INNERVATION
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SALIVARY GLANDS
Extrinsic glands:
parotid,
submandibular, and
sublingual glands
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PAROTID GLAND
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SUBMANDIBULAR GLANDS
Divided into 2 arms: the larger (superficial) and the smaller arm (deep) by mylohyoid
muscle.
Submandibular ducts drains into oral cavity, lateral to the base of frenulum of the
tongue
SUBLINGUAL GLANDS
Location: on sublingual fossa, lateral to submandibular ducts
Superior margin of the glands raises an elongate fold of mukosa sublingual folds.
Sublingual ducts opens on to sublingual folds,
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ACCESSORIES
DIGESTIVE GLANDS
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LIVER
Location: right
hypochondrium &
epigastric region or right
upper quadrant
Surfaces:
Diaphragmatic surface:
anterior, superior &
posterior direction
Visceral surface: inferior
direction. Covered by
visceral peritoneum
except in the fossa for
gallbladder & at the porta
hepatis.
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GALLBLADDER
Parts of gallbladder:
Fundus: may project
from the inferior border
of liver
Body of gallbladder.
Neck of gallbladder.
Duct: cystic duct
Hepatic duct & cystic
duct open to common
bile duct (ductus
coledochus) and
drains to descending
part of duodenum.
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GALLBLADDER
Projection to anterior
abdominal:
The fundus of
gallbladder can be
located at the angle
between the right
border of rectus
abdominis muscle and
the lower costal
margin of the
vertebrae C10.
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PANCREAS
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PANCREAS
Tail
Body
Head
Pancreatic ducts:
Major pancreatic duct : begins in the tail of the pancreas. The main pancreatic duct
join the bile duct and forms the papilla of Vater, which enters the descending part of
the duodenum at the major duodenal papilla of Vater.
Minor pancreatic duct: drains into the duodenum, above the major duodenal papilla
at the minor duodenal papilla
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BLOOD SUPPLIES
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Superior mesenteric
artery
Celiac
trunk
Superior mesenteric
artery
Inferior mesenteric
artery
Celiac trunk
Abdominal
aorta
FOREGU
T
AORTA
ABDOMINALIS
MIDGUT
HINDGU
T
Inferior mesenteric
artery
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Splenic artery:
Celia
c
trunk
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Gastro-omenta
(Gastroepiploic) artery
Splenic artery
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INFERIOR PANCREATICODUODENAL
ARTERY
SUPERIOR MESENTERIC
ARTERY
JEJUNUM
JEJUNAL
ARTERIES
ILEOCOLIC
ARTERY
ILEAL ARTERIES
APPENDICULAR ARTERIES
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Superior rectal artery: supplies the rectum & canal anal above the
pectinate line
Divide into 2 terminal branch at the level vertebra SIII: right & left
brances.
Anastomose: middle rectal artery (branch of internal illiac artery) &
inferior rectal artery (branch of internal pudendal artery)
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SIGMOID ARTERIES
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VENOUS DRAINAGE
OF THE GASTROINTESTINAL VISCERA &
ASSOCIATED ORGANS
PORTAL VEIN
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PORTAL VEIN
Venous blood from stomach, duodenum, jejunum, ileum
colon, rectum, pancreas, gallbladder & spleen enters the
liver through hepatic portal vein sinusoids of liver
hepatic veins drains into inferior vena cava enters
the right atrium of the heart.
Formed by the union of the splenic vein & superior
mesenteric vein, at the level of the vertebra LII.
Course: passed posterior to the superior part of the
duodenum & enters the hepatic portal vein with the bile
duct & proper hepatic artery.
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PORTAL VEIN
PORTAL
VEIN
SPLENIC VEIN
INFERIOR MESENTERIC VEIN
SUPERIOR MESENTERIC VEIN
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PORTOCAVAL SYSTEM
Umbilicus
paraumbilical veins (portal) & epigastric veins (systemic)
Anal canal
superior rectal vein (portal) with the middle rectal & inferior rectal veins
(systemic)
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PORTOCAVAL SYSTEM
Tributaries to azygos vein
V. PORTA
ROUND LIG. (LIG. TERES
HEPATIS) &.PARAUMBICAL VEINS
Superficial veins on
abdominal wall
INFERIOR VENA
CAVA
SUPERIOR RECTAL
VEIN
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PORTOCAVAL SYSTEM
Portal vein obstruction portal hypertension
Caput medusae at the umbilicus
Esophageal varices at the gastroesophageal
junction
Haemorrhoids at the anorectal junction
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LYMPHATICS
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LYMPHATICS
Gastric nodes lies along lesser curvature. Receive lymph from the
esophagus, lesser curvature, posterior-anterior-inferior aspect of the
stomach.
Hepatic nodes lies with hepatic artery. Receive lymph from the
stomach, duodenum, liver, gallbladder & pancreas.
Ileocolic nodes lies along ileocolic artery. Receive lymph from the
terminal ileum, appendix, cecum, ascending colon.
INNERVATION
Parasymphatetic :
Increase peristaltic movement
Increase secretion of the digestive glands
Symphatetic :
Inhibitory to peristalsis
Increase contraction of the sphincter muscle
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PARASYMPHATETIC
Constricts pupil
Inhibits tear
glands
Increases
salivation
Slows heart
SYMPHATETIC
Stimulates tear
glands
Dilates pupil
Inhibits
salivation,
increases
sweating
Accelerates heart
Dilates bronchi
Constricts
bronchi
Increases
digestive
function of
stomach
Increases
digestive
function of
intestine
Contracts
bladder
Decreases
digestive
functions of
stomach
Secretes
adrenalin
Decreases
digestive
function of
intestine
Inhibits bladder
contraction
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2.
3.
4.
5.
When someone has ill, why all the food taste bitter?
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7.
8.
9.
10.
11.
12.
What are the distinguishing features of the large intestine compared to the
small intestine?
13.
Why might a patient with a cancer of the stomach present with obstructed
pancreatic drainage?
14.
Which region of the large bowel is most likely to suffer from ischemia and why?
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16.
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18.
Why must the patient hold his breath during liver biopsy?
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20.
21.
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CASE STUDIES
1. Gastric ulcer
2. Liver abcess
3. Appendicitis
THANK YOU
SEE YOU IN THE LAB. PRACTICE
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REFERENSI
Kuliah Anatomi Gastrointestinal FKUI, FK
Unlam, PSPD FKIK UIN
Grays Anatomy
Textbook of Anatomy, Hollinshead
Clinical Anatomy for medical students, Snell
Grants Method of Anatomy
Pocket Examiner in Regional and Clinical
Anatomy, Abrahams
Case Studies in Anatomy, Lachman
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