ORAL CAVITY & ASSOCIATED GLANDS OF DIGESTIVE SYSTEM DIGESTIVE SYSTEM Function: comprises oral cavity, alimentary tract

t (esophagus to anus) and the associated glands (major salivary glands, pancreas, liver and gallbladder) Ingestion, mastication, deglutition, digestion, absorption and elimination

Oral Mucousa - lined by wet stratified squamous non-keratinized epithelium. Gingiva and hard palate lined by a partial to complete keratinized stratified squamous epithelium Boundaries of oral cavity: Anteriorly- Lips Posteriorly- Palatoglossal folds Saliva- produced by the 3 pairs of major salivary glands (parotid, submandibular, sublingual) Salivary glands produce and release the ff: a. salivary amylase - enzyme which will breakdown carbohydrate b. Lactoferrin c. Lysozymes d. Antibacterial agents e. Secretory IgA LIPS- Guards the entrance into the oral cavity - Compose of skeletal muscle fibers (mobility) - divided into: External Vermilion zone Internal (wet, mucous) External Lip follicle Vermilion zone - pink region; covered with a thin skin; no hair follicle and sweat gland; occasional sebaceous glands. Rete apparatus - interdigitation between epithelium and the connective tissue component is highly developed so that capillary loops of dermal papillae are close to surface of skin imparting a pink color to this area. Internal/Mucous/wet - lined by stratified squamous non-keratinized epithelium - subepith Connective tissue- dense irregular collagenous type; mucous minor salivary glands - covered with a thin skin; assted with sweat glands; sebaceous glands and hair

TEETH- Humans have 2 sets I. Milk (Deciduous)- 20 teeth II. Adult (Permanent)- 32 teeth 20- succedaneous 12- molars -Permanent dentition is evenly distributed between maxillary and mandibular arches. -These teeth have different forms, number of roots and function. General Structure: Alveolus- bony socket wherein each tooth is suspended Periodontal Ligament- dense collagenous connective tissue Crown- visible portion of a tooth in the oral cavity Root- part of the tooth that is housed within the bony socket Cervix- portion between the crown and root; where the enamel and cementum meets Pulp- soft, gelatinous connective tissue which is enclosed by the calcified substance Apical Foramen- opening through which root canal communicates with periodontal ligament and where blood, lymph vessels and nerves enter and leave the pulp. Pulp subdivided into 2 spaces: 1. pulp chamber 2. root canal Mineralized structures: 1. Enamel- covers the dentin on the crown area 2. Dentin- surrounds the pulp chamber and root canal; bulk of hard substance 3. Cementum- covers the dentin on the root area. Enamel- hardest substance in the body; translucent; its color is due to the underlying color of dentin. composition: 96%- Calcium hydroxyapatite 4%- organic material and water (keratin like, high molecular weight glycoprotein tyrosine rich Amelogenins and Enamelins Enamel is produced by ameloblast cells. It is non vital substance because amelolast die before tooth enters the mouth. Body cannot repair enamel. Accumulation of microorganisms in and on a defective enamel surface results to CARIES. Bacteria produce acids that will decalcify the enamel. Fluoride- increases the hardness of enamel making it more resistant to caries. Striae of Retzius- histologic successive rod segment sequence of calcified and hypocalcified enamel. Primary enamel cuticle- basal lamina like substance which covers the free surface of a newly erupted tooth. When the tooth emerge this disappears.

DENTIN - the second hardest tissue in the body; yellowish with a high degree of elasticity. -composition: 65%-70% Calcium hydroxyapatite 20-25% Organic matls (most Type I collagen proteoglycan & glycoprotein) 10% bound water - produced by Odontoblasts cells which is functional or vital in the maintenance of the tooth. Odontoblast cells are located at the periphery of the pulp and the cytoplasmic or odontoblastic extensions/processes which occupy a tunnel like spaces known as dentinal tubules (tissue fluid space), which extends from Pulp to dentino-enamel (crown) or dentinocemental (root) junction. - capable of self repair Dentinogenesis enamel is produced by ameloblasts daily Odontoblasts manufacture dentin daily. Quantity of manufactured dentin depends on the health of the mother prenatally and of the child postnatally. Along the length of dentinal tubules; dentin displays alternating regions of normal calcification and hypocalcification; recognized histologically as Lines of Owen which is analogous to Striae of Retzius (enamel) Dentin Sensitivity - mediated by sensory nerves fibers associated with odontoblasts, odontoblastic processes and dentinal tubules. Any disturbance of tissue fluid will depolarize the nerve fibers sending a signal to BRAIN interpreted as PAIN.

- 3rd hardest tissue of the tooth and is restricted to the root. - composition: 45-50% Calcium hydroxyapatite 50-55% organic material and bound water (organic material composed Of Type I collagen ) Apical part contains cementocytes within lacunae (lenticular spaces) Cementum Cellular cementum Acellular cementum - apical part of cementum with cementocytes - coronal part of cementum without cementocytes.

- Both cellular and acellular cementum have cementoblasts - Cementoblast cells are responsible for the formation of cementum and lines cementum at its interface with periodontal ligament. - Sharpeys Fibers are collagen fibers of periodontal ligament which are embedded in cementum and in alveolus. The ligament suspends the tooth in its bony socket. Odontoclasts are osteoclast like cell which resorbed the cementum. During exfoliation, deciduous teeth are replaced with their succedaneous counterpart. Odontoclasts resorb cementum and dentin of the root. Therefore cementum does not resorb readily like bones so, improperly positioned tooth wiyh proper or correct placement of force on tooth can reshape the bony socket.

PULP -composed of soft gelatinous connective tissue, rich in proteoglycans and glycosaminoglycans. -has extensive vascular and nerve supply with lymph circulating elements. -Three concentric zones: 1. Odontoblastic zone - composed of single layer of odontoblasts with processes that extends into adjacent dentinal tubules. 2. Cell-free zone - devoid of cells 3. Cell-rich zone - consists of fibroblasts, mesenchymal cells. Deepest zone of pulp; surrounds pulp core. Pulp Core - lacks adipose cells,; highly vascularized; occasional houses calcified elements Pulp stones or Denticles. Nerve fibers of Pulp: 2 types 1. Sympathetic (Vasomotor) fibers- controls the luminal diameter of blood vessel. 2. Sensory fibers- responsible for transmission of pain sensation Raschkows Plexus- thin myelinated pain fibers found deep in the cell-rich zone of pulp. Odontogenesis/tooth development: 6th-7th week of gestation -origin: oral ectoderm proliferates forming dental lamina (horse shoe-shape band of epithelial cells) surrounded by neural crest ectomesenchyme bud stage of tooth development deciduous teeth at maxillary and mandibular archescap stageas bud proliferates it forms a 3 layer structure known as cap which will constitute the plump enamel organ. Dental papilla fills up the enamel organ and collectively known as tooth germ. Dental papilla is responsible for the formation of pulp and dentin of tooth. Dental sac is vascularized membranous capsule which is formed by the ectomesenchymal cells. This will give rise to cementum, periodontal ligament and alveolus. Succedaneous lamina derived from dental lamina, a solid cord of epithelial cells grows deep into ectomesenchymeprecursor 20 succedaneous teeth These will replace the 20 deciduous teeth. At the 5th month of gestation, the remaining 12 permanent teeth arise from the posterior 2 dental laminae. Bell stage appearance of a new layer of cells stratum intermedium between stellate reticulum and inner enamel epithelium; also known as stage of morphodifferentiation or histodifferentiation. Ameloblast Odontoblast - enamel producing columnar cells of inner enamel epith. (simple squamous epith) - dentin producing columnar cells. Formed from histo differentiation of inner enamel epith cells and cells of dental papilla. Appositional stage - enamel and dentin adjoin each other. Junction between them is known dentinoenamel junction DEJ.

Odontoblastic process are cytoplasmic extension of odontoblasts w/c is surrounded by dentin. Dentinal tubule is the space occupied by odontoblastic process. Tomes process are the processes of the ameloblasts. Root Formation - characterized formation ALL the enamel and coronal dentin. The outer and inner enamel epithelia of the cervical loop elongate to form Hertwigs epithelial root sheath (HERS). Newly formed dentindifferentiate into cementoblastsproduce cementum matrixcalcified cementum. As root becomes longer crown will erupt into oral cavity. Periodontal ligament - located within the periodontal sac; between the cementum of the root and the alveolus. - dense irregular type I collagen fibers (principal fiber groups). The ends of these fibers are embedded in alveolus and cementum known as Sharpeys Fibers; which permits the periodontal ligament to suspend the tooth in its socket. 1. autonomic nerve fiber 2. pain nerve fiber 3. proprioceptive nerve fiber - regulate the luminal diameter of arterioles. - mediate pain sensation - responsible for spatial orientation;

Nerve supply:

- responsible for jaw-jerk reflex (involuntary opening of the jaw when one unexpectedly bites down on something hard. Alveolar process - bony continuation of mandible and maxilla which is divided into compartments each known as alveolus.(contains the root/roots) - bony structure which separates adjacent alveoli. - has 3 regions (cortical plate, spongiosa, alveo bone proper) - tough mucous membrane lined with stratified squamous epithelium - either fully or partially keratinized - 2-3 mm deep space between gingiva and tooth. - part of the gingival epith that attaches to the surface of enamel. - forms a collar around the neck of the tooth. - forms a barrier between the bacteria laden oral cavity and gingival CT

interalveolar septa

Gums/Gingiva

Gingival sulcus Junctional epithelium

Palate Hard palate

- separates the oral cavity from the nasal cavity. - anterior, immovable - oral aspect(mucousa)- stratified squamous keratinized or parakeratinized epithelium - dense irregular collagenous CT with adipose cells (anterior aspect) while (posterior aspect) with acini of mucous minor salivary glands -nasal aspect(mucousa)-pseudostrat epithelium with occasional stratified squamous non keratinized epithelium. - movable; core is made up of skeletal muscle. - oral aspect(mucousa) - stratified squamous non keratinized epithelium - dense irregular collagenous CT with mucous minor salivary glands w/c is continuous w/ hard palate. -nasal aspect(mucousa) - pseudostratified ciliated columnar epithelium - the posterior most extension of soft palate. - lined with stratified squamous non keratinized epithelium - largest struc ture of oral cavity; movable due to large intertwined mass of skeletal muscle fibers that compose its bulk.

Soft palate

Uvula

Tongue

2 groups of muscle fibers: a) extrinsic muscles b) intrinsic muscles

- responsible for moving the tongue - responsible for change of shape of tongue

Surfaces of tongue: a) dorsal- anterior 2/3 (lingual papillae); posterior 1/3 smaller b) ventral c) 2 lateral Sulcus Terminalis - shallow V-shape groove that separates the 2 dorsal regions of the tongue. - apex points posteriorly and contains a deep concavity foramen cecum.

Classification of lingual papillae: Filiform ; Fungiform ; Foliate ; Circumvallate 1.Filiform papillae - numerous slender structure that gives a velvety appearance of the dorsal part of tongue. - histo: lined w/ stratified squamous keratinized epithelium - function: for scraping food off a surface - no taste buds 2. Fungiform papillae - mushroom like ; has a slender stalk w/c connects a broad cap. - histo: lined w/ stratified squamous non-keratinized epithelium. - has taste buds 3. Foliate papillae - posterolateral part of tongue - have functional taste buds in neonate but disappears at age 2-3 years - ducts of serous minor salivary Glands of Von Ebner empty into the base of the furrows. (foliate papillae)

4. Circumvallate papillae

- 8-10 in number arranged in V-shape just anterior to sulcus terminalis - ducts of Von Ebner empty into this papillae. - has taste buds in groove and sides

Taste buds Taste Pore

- are intraepithelial sensory organs that function perception of taste. (3000) - Each taste bud has 60-80 spindle shape cells. - narrow opening w/c is located at the free surface of epithelium - average life span of 10 days

Cell types which comprise taste bud: 1. Type IV cells- basal cells 2. Type III cells- intermediate cells 3. Type II cells- light cells 4. Type I cells- dark cell Function: Nerve supply: cells basal cells as reserve cells; regenerate cells of taste buds. nerve fiber enter the taste bud and form synaptic junction w/ type I, II and III cells which will function in determining the taste.

Each cell type has long slender microvilli Taste hair Four primary taste sensation: a. salty b. sweet c. sour d. bitter Addn. Umami (glutamate receptor that senses delicious flavors) Each taste bud can discern each of four sensation and each taste bud specializes in 2 of the 4 tastes. The reaction to taste modalities is due to: a. presence of specific ion channels (salty and sour) b. presence of membrane receptors (bitter and sweet) Complex taste perception is due more to olfactory apparatus than to taste buds.

Associated Glands digestive system 1. Major salivary glands assisted w/oral cavity (Parotid, Submandibular, Sublingual glands) 2. Pancreas 3. Liver 4. Gallbladder Function: Salivary glands w/saliva a. facilitate the process of tasting food b. initiate digestion of food thru the action of PTYALIN, salivary AMYLASE and salivary LIPASE c .aid deglutition/swallowing by moistening food d. for protection by secreting antibacterial agents (lysozymes, lactoferrin, secretory IgA.} Function: Pancreas a. Manufacture a bicarbonate- rich fluid that buffers acid chime b. produces enzymes needed for the digestion of fats, proteins and carbohydrates. c. synthesizes and release endocrine hormones; eg insulin, glucagon, somatostatin gastrin and pancreatic polypeptide d. exocrine secretions are released into the lumen of duodenum when needed. Function: Liver a. the exocrine secretion (bile) is required for proper absorption of lipids b. the endocrine function b.1. metabolism of proteins, lipids and carbohydrates. b.2. synthesis of blood proteins and factors b.3. manufacture of vitamins and detoxification of bloodborne toxins Function: Gallbladder - concentrate, store and release bile into lumrn of duodenum Histologic appearance major salivary glands - branched tubuloalveolar glands. Connective tissue capsule provides septa that subdivides it into lobes and lobules; individual acini is also covered w/thin CT. Regions of salivary glands: a.) Secretory portion b.) Duct portion

Secretory portion of salivary glands: - arranged in tubules and acini - composed of 3 types of cells ( serous; mucous; myoepithelial cells) Serous cells - have single, round basally located nuclei; abundant secretory granules - rich in ptyalin located apically; has tight junctions; intercellular Canaliculi Mucous cells - nuclei are flattened; apical aspectof cytoplasm has abundant secretory granules Myoepithelial cells or Basket cells - has nucleus and long processes that envelop secretory acinus and intercalated ducts

Duct portion of salivary gland - have highly branched structures Intercalated ducts - smallest branches of system of ducts to which secretory acini and tubules are attached.; composed of small cuboidal cells Striated ducts - made up of several intercalated ducts; composed of single layer of cuboidal to low columnar cells. Intralobular ducts - formed by several striated ducts Interlobular ducts - formed from ducts arising from lobules united Interlobar ducts - formed from several interlobular ducts Terminal/Principal ducts - delivers saliva into the oral cavity Histo-physiology of major salivary gland: - produces 700- 1100 ml of saliva/day

Parotid gland - largest salivary gland - purely serous secretion - saliva has high levels of ptyalin and secretory IgA - a CT capsule which forms septa and divides the gland into lobes and lobules Non cancerous salivary gland tumor which usually affects the parotid gland Benign pleomorphic adenoma - treatment- surgical removal of parotid gland

Parotid gland and sometimes other major salivary gld is affected by viral infection Mumps- painful; usually affects children. If adult, sterility may be affected

Submandibular gland - 90% of the acini are serous producing. 10% are mucous producing - CT capsule is extensive and forms abundant septa.

Sublingual gland

- smallest among the salivary gland; almond shape - produces a mixed but mostly mucous saliva - scanty CT capsule and the duct system does not form terminal duct; instead open into the floor of mouth and into the duct of submandibular gland.

Pancreas

- situated at the posterior body wall deep into the peritoneum; has 4 parts ( uncinated process, head, body, tail ) - has a CT capsule, forms septa and divides gland into lobules - produces exocrine and endocrine secretions - Endocrine component Islet of Langerhans are scattered among the exocrine secretory acini. - Exocrine component is a compound tubuloacinar gland; produces bicarbonate rich fluid; has centroacinar cells; duct system begins within the center of acinus with the terminus of the intercalated ducts. Deliver their content into main pancreatic duct joins the common bile duct before opening in the duodenum at the papilla of Vater

The acinar cells of the exocrine pancreas manufacture, store and release the ff enzymes: pancreatic amylase; pancreatic lipase; ribonuclease; Dnase; proenzymes. Acute pancreatitis - a condition wherein the pancreatic digestive enzymes becomes active - often fatal - histo changes: inflammatory reaction ; necrosis of blood vessels; proteolysis of pancreatic parenchyma; enzymatic destruction of adipose cells of pancreas and surrounding tissue

Pancreatic CA - 5th leading cause of death of all cancers. - men are more susceptible than women Histophysio of endocrine pancreas: 2 hormones produced: a. insulin- decrease blood sugar b. glucagon- increase blood sugar =Insulin production starts with the synthesis of a single polypeptide chain of beta cell; insulin is released into the intercellular space in response to increase blood glucose like after a carbohydrate rich meal. The released insulin binds w/cell surface receptors (skeletal mm, liver, adipose cells). Transport proteins of cell membrane ( glucose permease)activated to take up Glucose thereby decreasing blood glucose level. =Glucagon is produced by the alpha cells and is released in response to a low blood glucose level. Acts mainly on hepatocytes by stimulating glycogenolytic enzymes which will break down glycogenglucose which is released into blood streamincrease blood glucose level. =Glucagon synthesizes glucose from non-carbohydrate sourcesgluconeogenesis (if glycogen depot is depleted)

=Somatostatin is manufactured by delta cells. Has both paracrine and endocrine effects. endocrine effect- reduce motility of smooth mm cells of alimentary tract and GB. =Gastrin is released by G-cells; stimulate the release of HCL, gastric motility and emptying. Diabetes mellitus is a metabolic disorder that results from: a. lack of insulin production by beta cells of islets of Langerhans b. defective insulin receptors on target cells 2 forms: 1. Type I 2. Type II 5-6X more than type I Complications: a. circulating disorders b. renal failure c. blindness d. gangrene e. stroke and MI (myocardial infarction) Cardinal signs of DM: a. polydipsia b. polyphagia c. polyuria LIVER the largest gland in the body; weighs 1500 gms; located right upper quadrant of abdominal cavity just below diaphragm. Divided into 4 lobes.

Gen structures: - completely covered by peritoneum except at the base area; this covering is made up of simple squamous epithelium over the dense irregular CT capsule Glissons capsule. - bulk of liver is composed of uniform parenchymal cells hepatocytes Anatomically superior area inferior area Blood supply: - convex

- hilum like indentation porta hepatis - receives oxygenated blood from right and left hepatic arteries and portal vein. - blood leaves liver thru hepatic veins while bile leaves liver thru right and left hepatic ducts GB

All nutrients absorbed in the GIT except chylomicrons are delivered directly to the liver via portal veinconverted by hepatocytes to glycogen. Hepatocytes arranged hexagonal shape lobules; classical lobules. Portal areas/triads - consists of 3 classical lobules with hepatic A, Portal V, Bile duct. Limiting Plate - a sleeve of modified hepatocytes which separates portal triad from liver parenchyma. Central vein - initial branch of hepatic vein which occupies longitudinal axis of classical lobule. Hepatocytes radiate like spokes of a wheel from central vein forming fenestrated plates separated by large vascular spaces Hepatic sinusoids. Hepatic sinusoid is lined by an endothelium composed of sinusoidal lining cell; in between these cells are gaps/fenestrae in clusters called Sieve plates. Kupffer cells -are associated with sinusoidal lining cells; these are macrophages w/endocytosed particulates and defunct erythrocytes. Space of Disse - narrow perisinusoidal space that separates the sinusoidal lining cells from the hepatocytes; contains type III collagen fibers without basal lamina; occasionally contain fat storing cells (Ito cells) and non-myelinated nerve fibers. Right and Left hepatic duct are formed from the merging of interlobular bile ducts; whose slender branches Canals of Herring receives bile from cholangioles and bile canaliculi. Hepatocytes are polygonal cells, closely packed to form plates of cells. The plasmalemma have lateral and sinusoidal domains. Lateral domains of hepatocytes membrane form intercellular spaces known as Bile canaliculi. Fasciae occludentes prevents leakage of bile between adjoining hepatocytes. Sinusoidal domains have microvilli which project into the space of disse. Hepatocytes actively synthesize proteins and has abundant complement of endosomes, lysosomes peroxisomes. There is varying amounts of lipid droplets mostly VLDL (prominent after a fatty meal). Glycogen deposits varies with the dietary state of a person, (adundant after feeding; few if fasting) Cirrhosis - a condition characterized by fibrosis, degeneration of hepatocytes and disintegration of the normal organization of liver. - alcoholics, obstructed biliary tract and chronic poisoning

Function of liver: a. produces the exocrine secretion bile and other endocrine secretion. b. metabolize the end product of absorption from alimentary canal, store and release them with hormonal and nervous signals. c. detoxify drugs and toxins d. transfer secretory IgA from space of Disse into bile e. kupffer cells phagocytose blood borne foreign particulate and defunct erythrocytes. Bile - 600-1200 ml/day - consists of bile salts (bile acids); bilirubin; glucoronide; phospholipids; lecithin cholesterol; plasma electrolytes (Na & bicarbonate) and IgA - function: - absorbs fat - eliminates 80% of cholesterol (synthesize by liver) - excrete blood borne waste product (bilirubin)

Bile salts emulsify fats in small intestines to facilitate their digestion. Absence of bile salts leads fatty stool. Bilirubin is a water insoluble yellowish green pigment; toxic end product of haemoglobin degradation. When defunct RBC are destroyed in the spleen by macrophages and in liver by Kupffer cellsbilirubin is released in blood streambound to plasma albuminfree bilirubin (endocytose by hepatocytes) Glucuronyltransferase+glucuronidebilirubin glucuronide (conjugated bilirubin)some Released bloodstream but most excreted into bile canaliculito be eliminated in feces. Jaundice - yellowish discoloration of the skin due to the high levels of free bilirubin or conjugated bilirubin in the bloodstream. 2 types: a. obstructive jaundice- decrease in bilirubin conjugation either due to a.1. hepatocyte malfunction (hepatitis) a.2. obstructed bile ducts b. Hemolytic jaundice- increase hemolysis of RBC thereby producing much free bilirubin even if hepatocytes are unimpaired.

LIPID METABOLISM The surface absorbing cells of small intestines releases chylomicrons which enters lymphatic system and through hepatic artery, it reaches liver. Within the liver these are degraded FA and Glyceroldesaturated and used to synthesizephospholipid and cholesterol or degraded into acetyl coA (2 molecules of acetyl coA combine to formaceto acetic acid some converted to acetone but much beta hydroxybutyric acid (ketone bodies) In Diabetes or Starvation concentration of ketone bodies in the blood becomes too high; this condition is known as Ketosis. If left untreated; blood pH decreases result to acidosis. CARBOHYDRATE AND PROTEIN METABOLISM Liver maintains normal level of glucose in the blood, by transporting glucose from blood into hepatocytes and store it as GLYCOGEN. If there is a drop of glucose below normal GLYCOGENOLYSIS (hepatocytes hydrolyze glycogen into glucose and transport it to space of disse) or liver can synthesize glucose from other sources eg fructose and galactose & non carbohydrate sources eg amino acids GLUCONEOGENESIS. Liver also eliminates blood borne ammonia convertingurea Hepatic coma is a condition wherein there is excessive blood ammonia; indicating impaired liver function or decrease blood flow to liver. 90% of blood proteins are manufactured liver eg. needed for coagulation (fibrinogen, factor III, accelerator globulin and prothrombin) eg needed for complement reaction eg needed in the transport of metabolites and albumins All globulins except gamma globulin are synthesize in the liver. All non-essential amino acids are synthesize in the liver. Liver serves as storage for vitamins A, D and B12. Hepatocytes are long lived w/a lifespan of 150 days. If destroyed with hepatotoxic drugs or in excision; liver cells will regenerate to its normal architecture and size. GALLBLADDER - Small pear shape organ located on the inferior aspect of liver. - Store 70 ml of bile - Function: store, concentrate and release bile into duodenum when required. - Parts: neck & body Layers: Epithelium; lamina propia; smooth muscle; serosa/adventitia Lumen of GB is lined with simple columnar epith compose of 2 cell types a. clear cells - more common b. brush cells - rare

cytoplasm - mucinogens Lamina propia compose of vascularized loose CT; neck part has tubuloalveolar glands

Extrahepatic ducts Right and Left hepatic duct unite to formcommon hepatic duct +cystic duct (GB) common bile duct+pancreatic ductto form Ampulla of Vater (opens at duodenal papilla into duodenal lumen. The opening of the CBD and pancreatic duct is controlled by 4 sphincter mm collectively called SPHINCTER OF ODDI 1.Sphincter choledochus 2.Sphincter pancreaticus - surrounds and controls terminal part of CBD to stop bile flow into duodenum. - surrounds and controls terminal part of pancreatic duct to stop pancreatic juices from entering duodenum and prevents bile into pancreatic duct. - surrounds and control ampulla of vater and prevents entry bile & pancreatic juices into duodenum. - facilitate entry of bile into lumen of duodenum

3 .Sphincter ampullae 4. Fasciculus longitudinalis

Gallstones (cholelithiasis) more common in females in their forty. sign/symptom: excruciating pain

- when gall stones enter and is trapped in cystic or CBD and the flow of bile is obstructed.

80% - cholesterol gallstones; large; pale yellow; few in number and multi faceted 20%- pigment stones (calcium salts of bile and calcium bilirubinate) smaller; black; ovoid and numerous Both types are radiolucent.