Splanchnology

Splanchnology
 Composition:
 Alimentary system
 Respiratory system
 Urinary system
 Reproductive system
 Characters of viscera
 Most of viscera organs lies in the thoracic, abdominal
and pelvis cavities
 All of them communicate with external environment
through some orifices or channels
 Reference lines of thorax

Anterior median line

Sternal line
Midclavicular line
 Reference lines of thorax

Posterior median line

Anterior axillary line

Midaxillary line Scapular line

Posterior axillary line

 The abdominal regions
——Nine regions

R. hypochondriac Epigastric region

region
L. hypochondriac region
R. lateral regions
L. lateral regions
R. inguinal region
Umbilical region

L. inguinal region
Pubic region
 The abdominal regions
——Four quadrants
 Left and right upper
quadrants
 Left and right lower
quadrants
The Alimentary System
 Composition
Alimentary canal
 Mouth
 Pharynx
 Esophagus Superior alimentary canal
 Stomach
Duodenum
 Small intestine Jejunum
Ileum Inferior alimentary canal
 Large intestine

Alimentary glands
 Major salivary glands
 Liver
 Pancreas

Function: ingestion, digestion, absorption, egesting

Major salivary glands
Mouth Pharynx

Esophagus

Stomach
Liver

Duodenum Pancreas
Large intestine

Ileum
Jejunum
Alimentary canal
The Oral Cavity
 The Oral Cavity
 Consists of two parts
 Oral vestibule : between cheeks and
lip and teeth
 Oral cavity proper : within arch of
teeth
 Boundaries of oral cavity proper
 Anterior and lateral: gum and teeth
 Posterior: isthmus of fauces
 Roof: palate
 Floor: tongue, muscles and mucous
membrane
 Oral vestibule leads, by the space
behind the molar teeth, into the oral
cavity proper
 Palate
 Two parts
 Hard palate : anterior 2/3，
formed by the maxilla and
palatine bone
 Soft palate : posterior 1/3
 Velum palatinum
 Uvula
 Palatoglossal arch
 Palatopharyngeal arch
 Isthmus of fauces formed by
uvula, free border of velum palatinum,
both side of palatoglossal arches,
and root of tongue.
Teeth
 Teeth

General features
 Two sets:
 Deciduous

 Permanent

 Classification:
 Incisors

 Canine

 Premolars

 Molars
 Deciduous teeth
 20 in number, ten teeth in each mandibular and maxillary
arch
 Deciduous central incisor, deciduous lateral incisor,
deciduous canine , first deciduous molar ，second
deciduous molar in each quadrant
Upper jaw Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ total 20
Lower jaw in. in. can. mol. mol.

 Eruption: stars at about 6 month of age and continues to

beginning of 3rd year
 Shedding: occurs between 6th and 12th years with
replacement by permanent teeth
Deciduous teeth

Deciduous central incisor

Deciduous lateral incisor
Deciduous canine
First deciduous molar
Second deciduous molar
 Permanent teeth (adult)
 32 in number，sixteen in each mandibular and maxillary arch
 Two incisors, one canine, two premolars, and three molars in
each quadrant
Upper jaw 1 2 3 4 5 6 7 8 total 32

Lower jaw

 First permanent molar－ appears at about 6 years

 Third molars (wisdom teeth)－many erupt at 18

3 7
Permanent teeth
3rd molar
2nd molar
1st molar
2nd premolar
1st premolar
Canine
Lateral incisor
Central incisor
 Teeth
Part and structure of the teeth
 Each tooth consists of 3 parts:
 Crown
 Neck
 Root
 Dental cavity
 Pulp chamber
 Root canal transmits the nerves
and vessels to and from the dental
cavity through the apical foramen
 Teeth
 Tooth tissues
 Dentine － is a yellowish white
tissue, that forms the bulk of tooth.
 Enamel －is a hard, white tissue
that covers the crown of the tooth
 Cement －is an unusual form of
bone that covers the root of the
tooth
 Dental pulp formed connective
tissue, blood vessels and nerves.
 Teeth
 Periodontal tissue
 Periodontal membrane
 Alveolar bone
 Gum
Teeth
 Tongue
Two parts: divided two parts by v-
shaped terminal sulcus
 Body of tongue －anterior 2/3
 Apex of tongue －free rounded
tip
 At the apex of terminal sulcus is
a small median pit, the
foramen cecum of tongue
 Root of tongue － posterior 1/3
 Tongue
Lingual mucous membrane
 Papillae of tongue
 Filiform papillae
 Fungiform papillae
 Foliate papillae contain taste
buds
 Vallate papillae
 Lingual tonsil
－masses of submucosal
lymphoid tissue on the root of
tongue
Inferior surface of tongue

Frenulum of tongue
－a midline fold of mucous
membrane connecting tongue to
floor of mouth
Sublingual caruncle
－small elevation

Sublingual fold
 Muscles of tongue

Intrinsic muscles of tongue

 Involved in changing shape of
tongue
 Include longitudinal, transverse
and vertical muscles of tongue
 Tongue
 Extrinsic muscles of tongue
 Genioglossus
 Arises from mental spine of
mandible and inserts into either
side of midline of tongue
 Action: acting together draw
tongue forward and downward
(depresses and protrudes
tongue ); acting along making
apex of tongue to opposite side
 Hyoglossus
 Styloglossus
 Involved in determining shape
and position of tongue
 Major salivary glands
Parotid gland
 Superficial part: triangular in shape,
lies below and in front of the external
acoustic meatus, and partially covers
the masseter.
 Deep part: lies deep to medial
pterygoid .
 Parotid duct:

arises from anterior border of gland,

runs over the masseter a finger’s
breadth below the zygomatic arch to
pierce the buccinator and opens into the
mouth cavity, opposite the upper second
molar tooth
 papilla of parotid duct
opposite the upper second molar tooth
 Major salivary glands
Submandibular gland

 Position: lies in submandibular

triangle, between anterior and
posterior bellies of digastric
 Duct opens on to sublingual
caruncle
 Major salivary glands

Sublingual gland
 Position: situated beneath the
mucous membrane of the floor of
mouth（sublingual fold）

 Ducts
 Major sublingual duct－opens
onto the sublingual caruncle
 Minor sublingual ducts－open
onto the sublingual fold
 The Pharynx

General features
 A –fibromuscular tube, part of
digestive and respiratory systems
 Extends from base of skull to the
inferior border of cricoid cartilage
(lower border of C6 level)
uvula
Three segments
epiglottis
 Nasopharynx
 Oropharynx
 Laryngopharynx
 The Pharynx
Nasopharynx —posterior to nasal
cavities
 Extends from the base of skull to
level of soft palate below
 Features
 Pharyngeal opening of auditory tube
 Tubal torus
 Pharyngeal recess
 Tubal tonsil
 Pharyngeal tonsil
 The Pharynx
Oropharynx －posterior to oral
cavity
 Lies below soft palate, extends
to upper border of epiglottis
 Features
 Median glossoepiglottic fold
 Epiglottic vallecula
 Palatine tonsil －lies within
tonsillar fossa
 The Pharynx
Laryngopharynx －posterior to
larynx
 Extends from upper border of
epiglottis to the level of lower
border of C6
 Piriform recess －a deep
depression on each side of
aperture of larynx, common side
for lodgement of foreign bodies (for
example, fish bones)
 The Pharynx

Lymphatic ring
 Consists of
 Pharyngeal tonsil
 tubal tonsil
 Palatine tonsil
 lingual tonsil
 Forming a circular band of
lymphoid tissue at
oropharyngeal isthmus
 The Esophagus
 General features
－ a muscular tuber about
25cm long, connecting the
pharynx at level of C6 vertebra,
passes through the diaphragm
at level of T10 vertebra and
after 1~2 cm enters the
stomach
 Division
 Cervical part
 Thoracic part
 Abdominal part
 The Esophagus
★Three constrictions
1. Where it beginning, 15cm from
incisors, lies at level of C6, is the
narrowest part of the esophagus
2. Where it is crossed by left
principal bronchus, 25cm from
incisors, lies at level of intervertebral
disc between T4 and T5.
3. Where it passes through the
esophageal hiatus of diaphragm,
40cm from incisors, at level of T10

Foreign bodies can lodge and carcinoma of esophagus is

more frequently found in these constrictions
 The Stomach
Shape
 Two surface: anterior and posterior
 Two curvatures
 Lesser curvature : short, concave and
directed to the right and upward, near its lower
part is angular incisure
 Greater curvature : long, convex and directed
to the left and downward, at the junction of left
margin of esophagus and greater curvature is
cardiac incisure
 Two openings
 Cardia

 Pylorus
 The Stomach
 Four parts
 Cardiac part
 Fundus of stomach
 Body of stomach
 Pyloric part
 Pyloric antrum
 Pyloric canal
 Fundus of stomach

Cardiac part

Body of stomach

Pyloric canal Pyloric antrum

Pyloric part
 The Stomach
Structure of stomach wall
－consists of four usual layers
 Mucous membrane
 Submucous ( loose areolar tissue
connecting the mucous and
muscular layer)
 Muscular layer contains:
 The most superficial longitudinal
fibers
 Inner circular fibres

 Sphincter of pylorus
 Pyloric valve
 Innermost oblique fibres
 Serous (visceral peritoneum)
 The Stomach
Location
 Mainly parts is situated in the left
hypochondriac region
 Small in the epigastric region
 The cardia is situated to the left of T11, the
pylorus lies to the right of L1
 The Small Intestine
Duodenum
 About 5-7m long
 Division:
 Duodenum
 Jejunum
 Ileum Jejunum

Ileum
 Duodenum

Four parts
 Superior part
 Duodenal cap
 Superior duodednal flexure
 Descending part
 Inferior duodenal flexure
 Horizontal part
 Ascending part
 Duodenojejunal flexure
 Duodenum

Descending part
 Longitudinal fold of
duodenum
 Major duodenal papilla
the common opening of the
common bile duct and
pancreatic duct, 75cm from
incisors
 Minor duodenal papilla
 Duodenum

 Suspensory muscle of duodenum

(ligament of Treitz), a surgical landmark,
descends from the right crus of diaphragm
to duodenal termination.
 aggregated
solitary lymphatic lymphatic
mesentery follicles follicles

Jejunum circular folds Ileum

Jejunum and ileum
 Jejunum and ileum
Characteristic Jejunum Ileum
Position Upper 2/5, upper left Lower 3/5, lower right
part of abdominal cavity part of abdominal cavity
Diameter Greater Less
Wall Thicker Thin
Circular folds Larger, numerous and Fewer，smaller and
dense villi less abundant villi
Vascularity More Less
Vasa recta Long Short
Color Deeper red Paler pink
Lymphatic follicles Solitary Aggregated
Fat in mesentery Less More
 Large Intestine

 Approximately 1.5m long,

 Five parts:
 Cecum
 Vermiform appendix
 Colon
 Rectum
 Anal canal
 Large Intestine
Features
 Colic bands
 Haustra of colon
 Epiploic appendices
 Cecum

 Position: lies in right iliac fossa

 Shape:
 Blind sac, first part of large intestine,
with largest diameter and thinnest
wall
 The ileum enters the cecum obliquely,
and partially invaginates into it,
forming the ileocecal valve
 Consists of two folds
 Probably delays flow of ileal
contents into large intestine
 Vermiform appendix
 Blind worm-like tube, 6－8cm
long, about 0.5cm in diameter
 Opens into posteromedial aspect
of cecum，about 2 cm below
ileocecal orifice
 The base of the appendix lies at
the point of convergence of three
colic bands (used as a guide to
find the appendix during
operation)
 Vermiform appendix

 Surface marking of the base

is at the so-called
McBurney’s point which is
at junction of lateral and
middle thirds of line joining
right anterior superior iliac
spine and umbilicus
 Vermiform appendix

Tip variable in position

 Preileal －7%

 Pelvic－41%

 Retrocecal －29%

 Retroileal－4%

 Subcecal－17%
 Vermiform appendix

Mesoappendix
 Triangular mesentery－
extends from terminal part
of ileum to appendix
 Appendicular a. runs in free
margin of the
meseoappendix then along
wall of appendix
 Colon
 Ascending colon
 right colic flexure
 Transverse colon
 left colic flexure
 Descending colon
descends almost vertically
from left colic flexure to
sigmoid colon at left iliac
crest.
 Sigmoid colon －extends
from descending colon to
rectum at level of S3.
 Rectum
 Position: within pelvic cavity, extends
from S3 to pelvic diaphragm.
 Curves
 Sagittal plane
 Sacral flexure : convex backward
 Perineal flexure : convex forward.
 Coronal plane
 Upper and lower part－convex to the right.
 Middle part－convex to the left.
 Lower part of rectum dilated, to from
ampulla of rectum
 Three transverse folds of rectum
 Anal canal
 Anal columns : 6 － 11 in number
 Anal valves
 Anal sinuses
 Anorectal line
 Dentate line
 Above line, of endodermal origin
 Below line, of ectodermal origin
 Anal pecten
 White line (Hilton’s line)
 Anus
 Anal sphincters
 Sphincter ani internus
 Sphincter ani externus
Alimentary glands
 The Liver

Shape －two surfaces

 Diaphragmatic surface
 Convex and smooth
 Divided into right and left lobes by
falciform lig. of liver
 Visceral surface
 The Liver
Visceral surface －has a H-shaped
fissures and grooves
 Cross-bar of H — porta hepatis
Traversed by
 Right and left hepatic ducts

 Left and right branches of proper

hepatic artery and hepatic portal vein

 Nerves and lymphatic vessels
 These structures which are surrounded

by connective tissue called hepatic

pedicle
 Four lobes: left, right, quadrate and
caudate lobes
 The Liver
 Left limb of H
 Anteriorly: fissure for ligamentum teres
hepatis
 Posteriorly: fissure for ligamentum
venosum
 Right limb of H
 Anteriorly: fossa for gallbladder
 Posteriorly:
 Sulcus for vena cava
 Secondary porta of live
 The Liver

 Inferior border –thin and

sharp
 Notch for ligamentum teres
hepatis
 Nothch for gallbladder
 The Liver

 Position:
 Most of liver lies in the right
hypochondriac region and
epigastric region
 less part extending into the left
hypochondriac region
 The Liver
Surface projection
 Upper border: on the right
midclavicular line it extends
the level of 5th rib
 The Liver
Surface projection
 Lower border:
 Normally, the right lobe
extends just beneath the
costal margin, it doesn’t
down beyond the costal
margin;
 on the anterior median line
its lower border crosses a
point about 3~5cm below
the xiphoid process.
 In children, the liver being
larger in proportion to the
body than in the adult stage,
it extends below the costal
arch within in 2cm.
 The Liver

The segments of the liver

 The segmentation of the liver,
bases upon the principal
divisions of the proper hepatic
artery and accompanying
hepatic ducts and hepatic
portal vein－Glisson system.
 The hepatic veins, however do
not follow the same pattern
and vary: their main tributaries
tend to run rather
intersegmental.
 Gallbladder
 Position :
lies in fossa for gallbladder on
visceral surface of liver
 Four parts
 Fundus of gallbladder
Surface projection: at the junction
of right midclavicular line and
right costal arch
 Body of gallbladder
 Neck of gallbladder
 Cystic duct
 Function: stores and
concentrate bile
 Extrahepatic Biliary Apparatus

Consists of
 Gallbladder
 Left and right hepatic ducts
 Common hepatic duct
 Common bile duct
 Biliary duct system

 Left and right hepatic ducts

unite outside of liver to form the
common hepatic duct
 Cystic duct joins common hepatic
duct to form common bile duct
 Biliary duct system
Hepatopancreatic ampulla
(ampulla of Vater)
 Common bile duct and pancreatic duct
run obliquely through the wall of the
descending part of duodenum where the
two ducts usually unite to form the
hepatopancreatic ampulla
 Which rounded by sphincter of
hepatopancreatic ampulla (sphincter
of Oddi), each has an independent
sphincteric mechanism for regulating
flow, and opens at the major duodenal
papilla
 right hepatic duct left hepatic duct
cystic duct

common hepatic duct

common bile duct

pancreatic duct

hepatopancreatic ampulla
major duodenal (ampulla of Vater)
papilla
Bile is secreted by the liver cells Biliary ductuli Right and left hepatic ducts

Common hepatic duct Cystic duct Gallbladder (store, concentrate)

when the fat enters the small intestine,

the gallbladder contracts, the sphincter
of hepatopancreatic ampulla relax

Common bile duct

Major duodenal papilla

Duodenal cavity
Extrahepatic Biliary Apparatus
Magnetic resonance cholangiopancreatogram.
 The Pancreas

Shape and Position

 A soft yellowish lobulated
gland
 Lies behind the peritoneum
on the posterior abdominal
wall, roughly at the level of
of L1~L2
 The Pancreas
Four parts
 Head
 Lies within the cancavity of the C-
shaped curvatune of duodenum
 Uncinate process－ a projection
to the left from the lower part of
the head behind the superior
mesenteric vessels.
 Neck－narrow part, overlies the
superior mesenteric vessels and
beginning of the portal vein
 Body－triangular in cross section,
passes upward to the left across the
midline
 Tail－extends to the hilum of spleen
in the splenorenal ligament
 Cystohepatic triangle
(Calot’s Triangle)
 Boundaries
 Common hepatic duct on
the left
 Cystic duct on the right
 Live superiorily
 Content: cystic artery
 The Pancreas
 Pancreatic duct
 Main Pancreatic duct
 Begins at tail and
throughout gland
 Joins common bile duct
before entering descending
part of duodenum at major
duodenal papilla
 Accessory pancreatic duct
 Opens 2cm above main
duct at lesser duodenal
papilla
 The Pancreas
Function
The pancreas is both an exocrine and an endocrine
gland. The exocrine portion of the gland produces a
secretion that contains enzymes that are capable of
hydrolyzing proteins, fats, and carbohydrates. The
endocrine portion of the gland, the pancreatic islet,
produces the hormones insulin and glucagons that play
a key role in carbohydrate metabolism.
transverse folds of rectum