ORAL REGION

-includes the oral cavity, teeth, gingivae, tongue, palate, region of the palati
ne tonsils
-deglutition voluntary phase initiated in the OC; involuntary phase occurs in th
e pharynx
ORAL CAVITY
-aka mouth
-two parts: the oral vestibule & the oral cavity proper
-oral vestibule: slit-like space b/n teeth & gingivae and lips & cheeks; communi
cates w/ exterior via oral fissure, whose size is controlled by the orbicularis
oris (sphincter of the oral fissure), the buccinator, risorius, depressors & ele
vators of the lipds
-OC proper: space b/n upper & lower dental arches or arcades (maxillary & mandib
ular alveolar arches & the teeth they bear); limited LATERALLY and ANTERIORLY by
the dental arches; ROOF is formed by the palate; POSTERIORLY, it communicates w
/ the oropharynx
-when the mouth is closed & at rest, the oral cavity is fully occupied by the to
ngue
LIPS AND CHEEKS
-lips: mobile, musculofibrous folds surrounding the mouth; extends from nasolabi
al sulci & nares laterally and superiorly to the mentolabial sulcus inferiorly;
covered externally by skin & internally by mucous membrane; FUNCTIONS AS THE VAL
VES OF THE ORAL FISSURE, containing the sphincter (orbicularis oris); *transitio
nal zone of the lips
-labial frenula: free-edged folds of mucous membrane in the midline; the one ext
ending to the upper lip is larger; some smaller frenula in the premolar vestibul
ar regions
-lips supplied by the superior & inferior labial arteries (branches of the facia
l arteries) -> anastomose w/ each other in the lips to form an arterial ring
-upper lip: supplied by the superior labial branches of the facial & infra-orbit
al arteries; supplied by the superior labial branches of the infra-orbital nerve
s of CN2; drains to submandibular lymph nodes
-lower lip: supplied by the inferior labial branches of the facial & mental arte
ries; supplied by the inferior labial branches of the mental nerves of CN5; drai
ns to the submental lymph nodes
-cheeks: essentially same strcuture as lips w/ w/c they are continuous; form the
movable walls of the oral cavity; its external aspect anatomically constitutes
the BUCCAL REGION, bounded ANTERIORLY by the oral and mental regions (lips & chi
n), SUPERIORLY by the zygomatic region, POSTERIORLY by the parotid region, INFER
IORLY by the inferior border of the mandible
-prominence of cheek: at the junction of the zygomatic & buccal regions; aka CHE
EKBONES
-principal cheek muscles: buccinators
-cheeks supplied by the buccal branches of the maxillary artery & innervated by
buccal branches of the mandibular nerve
GINGIVAE
-composed of fibrous tissue covered w/ mucous membrane
-gingiva proper: attached gingiva; firmly attached to the alveolar processes of
the mandible & maxilla & necks of teeth
-superior & inferior lingual gingivae -> tongue side
-maxillary & mandibular labial gingivae -> lips side
-buccal gingivae -> cheek side
-gingiva proper: normally pink, stippled, keratinizing
-alveolar mucosa: unattached gingiva; normally shiny red & non-keratinizing
PALATE
-forms the arched roof of the mouth & the floor of the nasal cavities

-separates the oral cavity from the nasal cavities & nasopharynx
-nasal surface of palate is covered w/ respiratory mucosa; inferior surface w/ o
ral mucosa, densely packed w/ glands
-hard anteriorly; soft posteriorly
HARD PALATE
-vualted (concave)
-mostly filled by the tongue at rest
-anterior 2/3 of the palate
-has a bony skeleton formed by the palatine processes of the maxillae and the ho
rizontal plates of the palatine bones
-incisive fossa: a depression in the midline of the bony palate posterior to the
central incisor teeth into which the incisive canals open; the nasopalatine ner
ves pass from the nose through a variable number of incisive canals & foramina t
hat open into the incisive fossa
-greater palatine foramen: medial to the 3rd molar tooth; pierces the lateral bo
rder of the bony palate; greater palatine vessels & nerve emerge from this foram
en & run anteriorly on the palate
-lesser palatine foramina: posterior to the greater palatine foramen; pierce the
pyramidal process of the palatine bone; transmit the lesser palatine nerves & v
essels to the soft palate & adjacent structures
SOFT PALATE
-movable posterior third of the palate
-suspended form the posterior border of the hard palate
-no bony skeleton
-palatine aponeurosis: strengthens the anterior aponeurotic part of the soft pal
ate; attaches to the posterior edge of the hard palate; thick anteriorly and thi
n posteriorly, where it blends w/ a poserior muscular part
-uvula: conical process that hangs from the curved free margin of the soft palat
e postero-inferiorly
-when you swallow, SP initially is tensed to allow the tongue to press against i
t, squeezing the bolus of food to the back of the mouth -> SP elevated posterior
ly & superiorly against the pharyngeal wall -> prevents passage of food to the n
asopharynx
-LATERALLY continuous w/ the wall of the pharynx
-joined to the tongue by the PALATOGLOSSAL arches
-joined to the pharynx by the PALATOPHARYNGEAL arches
-few taste buds in the epithelium of the oral surface of SP, posterior wall of t
he oropharynx, epiglottis
-fauces: space b/n the oral cavity & the pharynx; bound SUPERIORLY by the soft p
alate, INFERIORLY by the root of the tongue, LATERALLY by the pillars of the fau
ces (the palatoglossal & palatopharyngeal arches)
-isthmus of fauces: short constricted space that establishes the connection betw
een the OC proper & oropharynx; bounded ANTERIORLY by the palatoglossal folds, P
OSTERIORLY by the palatopharyngeal folds
-palatine tonsils: aka "the tonsils"; masses of lympoid tissue, one on each side
of the oropharynx; each is in a tonsillar sinus or fossa, bounded by the palato
glossal & palatopharyngeal arches & and the tongue
SUPERFICIAL FEATURES OF PALATE
-hard palate mucosa is tightly bound to the underlying bone
-deep to the mucosa are mucus-secreting palatine glands -> duct openinds give it
a pitted appearance (orange peel)
-incisive papilla: elevation of mucosa lying directly ANTERIOR to the underlying
incisive fossa
-transverse palatine folds or rugae: radiate laterally from the incisive papilla
; assist w/ food manipulation
-palatine raphe: narrow whitish streak; markes the site of fusion of the embryon
ic palatal processes (palatal shelves)

MUSCLES OF SOFT PALATE

-if SP is elevates, in contact w/ posterior pharyngeal wall -> closes isthmus of
the pharynx -> breathe thru mouth
-if SP drawn inferiorly, in contact w/ posterior part of tongue -> closes isthmu
s of fauces -> expired air passes thru nose
-tensing the SP pulls it tight at an intermediate level so that the tongue may p
ush against it
VASCULATURE AND INNERVATION OF PALATE
-palate has rich blood supply
-greater palatine artery on each side, a branch of the descending palatine arter
y -> passes thru greater palatine foramen -> runs anteromedially
-lesser palatine artery, a smaller branch of the descending palatine artery -> e
nters lesser palatine foramen -> anastomose w ascending palatine artery, a branc
h of the facial artery
-veins of the palate are tributaries of the pterygoid venous plexus
-sensory nerves of the palate are branches of the maxillary nerve (of CN5), whic
h branch from the pterygopalatine ganglion
-greater palatine nerve: supplies gingivae, mucous membrane, glands of most of t
he HP
-nasopalatine nerve: supplies mucous membrane of ant part of HP
-lesser palatine nerves: supply soft palate
-except for the tensor veli palatini supplied by mandibular nerve (CN V3), all m
uscles of the soft palate are supplied through the pharyngeal plexus nerves
TONGUE
-mobile muscular organ covered w/ mucous membrane
-partly in the OC & partly in the oropharynx
-main fxns: articulation, squeezing food into the oropharynx, mastication, taste
, oral cleansing
PARTS AND SURFACES OF TONGUE
-root, body, apex
-root of the tongue: attached posterior portion, extending between the mandiblem
hyoid, and the posterior surface of the tongue
-body: anterior, apprx 2/3 of the tongue b/n the root & apex
-apex: tip; anterior end; rests against the incisor teeth
-body and apex are extremely mobile
-2 surfaces: dorsum of the tongue (aka top; more extensive, superior, and poster
ior surface) & the inferior surface of the tongue (aka underside, rests against
the floor of the mouth)
-terminal sulcus of the tongue: V-shaped groove on the dorsum surface; angle poi
nts to the FORAMEN CECUM, the non-fxnal remnant of the proximal part of the embr
yonic thyroglossal duct form w/c the thyroid gland developed
-terminal sulcus divides dorsum to: presulcal anterior part & postsulcal posteri
or part
-midline groove overlying the lingual septum: divides ant part into R & L parts
-mucosa of the ant part is relatively thin & closely attached to the underlying
muscle; rough texture due to lingual papillae
-mucosa of posterior part is thick & freely movable; no lingual papillae; underl
ying LYMPHOID NODULES give an irregular, cobblestone appearance
-lymphoid nodules known collectively as LINGUAL TONSIL
-pharyngeal part of tongue constitutes the anterior wall of the oropharynx
-inferior surface covered w/ thin, transparent mucous membrane; connected to flo
or of the mouth via FRENULUM OF THE TONGUE, w/c allows the ant part of the tongu
e to move freely
-deep lingual vein on each side of the frenulum
-sublingual caruncle (papilla): present on each side of the base of the lingual
frenulum that includes the opening of the submandibular duct from the submandibu

lar salivary gland

MUSCLES OF THE TONGUE
-extrinsic muscles: alter the position of the tongue
-intrinsic muscles: alter its shape
-4 intrinsic & 4 extrinsic muscles in each half of the tongue are separated by a
median fibrous lingual septum
INNERVATION OF THE TONGUE
-all muscles except the palatoglossus receive innervation from CN 12, the hypogl
ossal nerve
-palatoglossus supplied by the pharyngeal plexus of the vagus nerve
-general sensation (touch & temp)
ant 2/3: lingual nerve, branch of CN V3 (mandibular nerve)
post 1/3 & vallate papillae: lingual branch of CN9 (glossopharyngeal)
-special sensation (taste)
ant 2/3: chorda tympani nerve, branch of CN7 (facial nerve)
post 1/3 & vallate papillae: lingual branch of CN9 (glossopharyngeal)
-twigs of the internal laryngeal nerve, a branch of the vagus nerve, supply most
general but some special sensation to a small area of the tongue ant to the epi
glottis
-sweetness @ apex
-saltiness @ lateral margins
-sourness & bitterness @ posterior part
VASCULATURE OF TONGUE
-arteries of tongue derived from the lingual artery from the external carotid ar
tery
-lingual -> passes thru hypoglossus -> dorsal lingual arteries supply root of to
ngue (lingual septum prevents comm) -> deep lingual arteries supply the lingual
body (comm @ apex) ->
-internal jugular vein -> lingual vein
-veins of the tongue are the dorsal lingual veins, w/c accompany the lingual art
ery; deep lingual veins, w/c begin at the apex of the tongue, run posteriorly be
side the the lingual frenulum to join the sublingual vein
-sublingual veins in elderly ppl often varicose (enlarged & tortuous)
-lymphatic drainage of the tongue is EXCEPTIONAL
-most of the lymphatic drainage converges toward and follows the venous drainage
-lymph form the tip of tongue, frenulum, central lower lip runs an independent c
ourse
-4 routes
------------------------PERITONEUM AND PERITONEAL CAVITY
-peritoneum: continuous, glistening, and slippery transparent serous membrane
-lines the abdominopelvic cavity & invests the viscera
-2 continuous layer: parietal & visceral; both consist of mesothelium
-parietal peritoneum: served by the same blood & lymphatic vasculature & same so
matic nerve supply as the region of wall it lines; sensitive to pressure, pain,
heat and cold, laceration (pain is generally well localized except that inferior
surface of the central part of the diaphragm -> phrenic nerves);
-visceral peritoneum: served by the same blood & lymphatic vasculature & viscera
l nerve supply as the organs it covers; insensitive to touch, heat and cold, lac
eration -> stimulated primarily by stretching & chemical irritation (pain is poo
rly localized) -> pain from foregut derivatives usually experienced in the epiga
stric region; midgut to umbilical; hindgut to pubic
-relationship of viscera to peritoneum:
>intraperitoneal organs: almost completely covered with visceral peritoneum (sto
mach, spleen); does not mean inside the peritoneal cavity; intraperitoneal organ

s have invaginated into the closed sac, like pressing your fist into an inflated
balloon
>extraperitoneal, retroperitoneal, subperitoneal organs: also outside the perito
neal cavity (external to the parietal peritoneum) and are only partially covered
with peritoneum (usu on just 1 surface). Retro (kidneys) are b/n the parietal p
eritoneum & posterior abdominal wall & have PP only on their anterior surfaces,
often w/ variable amt of intervening fat; subperitoneal (urinary bladder) has PP
only on its superior surface
-peritoneal cavity: within the abdominal cavity & continues inferiorly into the
pelvic cavity; potential space of capillary thinness b/n the parietal & visceral
layers; CONTAINS NO ORGANS but has a thin film of PERITONEAL FLUID (comp of wat
er, electrolytes, other substances from the interstitial fluid in adjacent tissu
es)
-peritoneal fluid lubricates the peritoneal surfaces -> frictionless envi for mo
vements of digestion; also contains leukocytes & antibodies that resist infectio
n
-lymphatic vessels, particularly on the inferior surface of diaphragm, absorb th
e peritoneal fluid
-peritoneal cavity is completely closed in MALES; there is a communication pathw
ay in FEMALES to the exterior of the body via uterine tubes, uterine cavity, vag
ina -> potential pathway of infection from exterior
PERITONEAL FORMATIONS
-PC has a complex shape
-PC houses a great length of gut, most of w/c is covered w/ peritoneum
-extensive continuities b/n the parietal and visceral peritoneum -> convey the n
eurovascular structures from the body wall to the viscera
-P & V peritoneum have a much greater SA than the outer skin -> highly convolute
d
-mesentery: double layer of peritoneum that occurs as a result of the invaginati
on of the peritoneum by an organ; constitutes a continuity of the V & P peritone
um; provides means of neurovascular comm b/n organ & body wall; connects an intr
aperitoneal organ to the body wall- usually the posterior abdominal wall (e.g. m
esentery of SI); have a core of CT w/ BVs & LVs, nerves, lymph nodes, fat
-SI mesentery: usu referred to simply as "the mesentery"
-transverse & sigmoid mesocolons; mesoesophagus; mesogastrium; mesoappendix
-omentum: double-layered extension or fold of peritoneum that passes from the st
omach & proximal part of the duodenum to adjacent organs in the abdominal cavity
-greater omentum: prominent, four-layered peritoneal fold that hangs down like
an apron from the greater curvature & proximal part of the duodenum; after desce
nding, it folds back & attaches to the ant surface of the transverse colon & its
mesentery
-lesser omentum: much smaller, double-layered paritoneal fold that connects the
lesser curvature & proximal part of duodenum to the liver; connects the stomach
to a triad of structures that run b/n the duodenum & liver in the free edge of t
he LO
-peritoneal ligament: consists of a double layer of peritoneum that connects an
organ w/ another organ or to the abdominal wall
liver is connected to the:
>anterior abdominal wall by the falciform ligament
>stomach by the hepatogastric ligament (membranous portion of LO)
>duodenum by the hepatoduodenal ligament (thickened free edge of LO, w/c
conducts the portal triad: PV, HA, BD)
-hepatogastric & hepatoduodenal ligaments are continuous
stomach is connected to the:
>inferior surface of diaphargm by the gastrophrenic ligament
>spleen by the gastrosplenic ligament (reflects to hilum of spleen)
>transverse colon by gastrocolic ligament (apron-like part of GO, w/c de
scends from the GC, turns under, ascends to the transverse colon)
-all continuous as well

-intraperitoneal organs almost entirely covered w/ VP, but every organ must have
an area not covered to allow entrance/exit of neurovascular structures
-BARE AREAS -> convery the neurovascular structures
-peritoneal fold: reflection of peritoneum that is raised from the body wall by
underlying blood vessels, ducts, and ligaments formed by obliterated fetal vesse
ls (e.g., the umbilical foldson the internal surface of the anterolateral abdomi
nal wall)
-peritoneal recess or fossa: pouch of peritoneum formed by a peritoneal fold (eg
omental bursa)
SUBDIVISIONS OF PERITONEAL CAVITY
-PC divided into greater & lesser sac
-greater sac: main & larger part of PC (surgical incision thru anterolateral abd
ominal wall enters it)
-lesser sac: aka omental bursa; lies posterior to the stomach & lesser omentum
-transverse mesocolon: mesentery of the TC; divides the AC into a supracolic com
partment, containing the stomach, liver spleen, and an infracolic compartment co
ntaining the SI and ascending & descening colon
-ICC lies posterior to the greater omentum& is divided into right & left infraco
lic spaces by the MESENTERY OF THE SI
-paracolic gutters: grooves b/n the lateral aspect of the ascending or descendin
g colon & the posterolateral abdominal wall; through these, there is free comm b
.n the supracolic & infracolic compartments
-omental bursa: extensive sac-like cavity that lies posterior to the stomach, le
sser omentum, and adjacent structures; has a superior recess, limited SUPERIORLY
by the diaphragm and the posterior layers of the coronary ligament; and an infe
rior recess, between the SUPERIOR parts of the layers of the greater omentum
-OB permits free movement of the stomach on the structures posterior & inferior
to it b/c the anterior & posterior walls of the OB slide smoothly over each othe
r
-OB communicates w/ greater sac via omental foramen or epiploic foramen, an open
ing posterior to the free edge of the LO; usu admits 2 fingers
-boundaries of OF:
>anteriorly: hepatoduodenal ligament
>posteriorly: IVC & right crus of diaphragm (covered anteriorly w/ PP; r
etroperitoneal)
>superiorly: the liver, covered w/ VP
>inferiorly: superior part of duodenum
ESOPHAGUS
-muscular tube; ave diameter of 2cm
-conveys food from pharynx to stomach; plays no role in digestion
-3 contrictions where adjacent structures produce impressions:
1. cervical constriction (upper esophageal sphincter): begins @ the pharyngoesop
hageal junction; caused by the cricopharyngeus muscle
2. thoracic (broncho-aortic) constriction: compound construction by the arch of
aorta and then the left main bronchus
3. diaphragmatic constriction: where it passes through the esophageal hiatus of
the diaphragm
-follows the curve of the VC as it descends through the neck & mediastinum
-has internal circular & external longitudinal layers of muscle
-superior third: external layer is composed of voluntary striated muscle
-inferior third: smooth muscle
-middle third: both types
-passes thru elliptical esophageal hiatus in the muscular right crus of the diap
hragm, just to the left of the median plane @ the level of the T10 vertebra
-terminates by entering the stomach at the cardial orifice of the stomach to the
left of the midline @ level of 7th left costal cartilage & T11 vertebra
-encircled by the esophageal nerve plexus distally
-food passes thru esophagus rapidly bc of the peristaltic action of its musculat

ure aided by gravity; can still swallow of inverted

-attached to the margins of the esophageal hiatus by the phrenico-esophageal lig
ament, an extension of inferior diaphragmatic fascia; this ligament permits move
ment of diaphragm & esophagus during respiration & swallowing
-abdominal part of esophagus: trumpet-shaped -> cardial orifice of the stomach,
widening as it approaches; ant surface is covered w/ peritoneum of the greater s
ac (cont w/ ant surface of stomach); fits into a groove on the posterior/viscera
l surface of the liver
-post surface of abdominal part is covered w/ peritoneum of the omental bursa (c
ont w/ post surface of stomach)
-right border is continuous w/ lesser curvature; left border is separated from t
he fundus by the cardial notch
-esophagogastric junction: lies to the left of the T11 vertebra; aka Z-line, whe
re a jagged line indicates abrupt change in mucosa from esophageal to gastric; i
mmediately SUPERIOR to this junction, the diaphragmatic musculature acts as a PH
YSIOLOGICAL INFERIOR ESOPHAGEAL SPHINCTER that contracts & relaxes; food stops h
ere momentarily -> sphincter is effective against reflux
-when not eating, lumen is normally collapsed superior to this level
-ARTERIAL SUPPLY:
>LEFT GASTRIC ARTERY, a branch of the celiac trunk
>LEFT INFERIOR PHRENIC ARTERY
-VENOUS DRAINAGE:
>SUBMUCOSAL VEINS -> PVS through LEFT GASTRIC VEIN
>SUBMUCOSAL VEINS -> SVS through ESOPHAGEAL VEINS entering the AZYGOS VE
IN
-LYMPHATIC DRAINAGE
>LEFT GASTRIC LYMPH NODES -> CELIAC LYMPH NODES
-INNERVATION
>ESOPHAGEAL PLEXUS formed by the VAGAL TRUNKS (becoming anterior & poste
rior gastric branches
>THORACIC SYMPATHETIC TRUNKS via GREATER (ABDOMINOPELVIC) SPLANCHNIC NER
VES and PREARTERIAL PLEXUSES
STOMACH
-specialized for accumulation -> chemically & mechanically prepares for digestio
n in the duodenum
-CHIEF FUNCTION IS ENZYMATIC DIGESTION
-gastric juice -> chyme -> passes fairly quickly to duodenum
-can hold 2-3 L of food
POSITION, PARTS, AND SURFACE ANATOMY OF STOMACH
-size, shape, position vary depending on persons
-R & L UQ or epigastric, umbilical, and left hypochondrium
-erect position: stomach moves inferiorly
-4 parts:
1. cardia: part surrounding the cardial orifice
2. fundus: dilated superior part related to the left dome of the diaphragm; limi
ted INFERIORLY by the horizontal plane of the cardial orifice
cardial notch: b/n esophagus & fundus
fundus may be dilated by gas, fluid, food, any combo
3. body: major part of stomach n/b fundus & pyloric antrum
4. pyloric part: funnel-shaped outflow region of the stomach; its wider part, th
e pyloric antrum, leads into the pyloric canal, its narrower part; lies at the l
evel of the TRANSPYLORIC PLANE
pylorus: distal, sphincteric region of the pyloric part; it is a marked thickeni
ng of the circular layer of smooth muscle that controls discharge of the stomach
contents through the pyloric orifice
-pylorus is normally tonically contracted except when emitting chyme
-gastric peristalsis at irregular intervals
-lesser curvature: the angular incisure (notch), the most inferior part of the c

urvature, indicates the junction of the body & pyloric part

-greater curvature
-unequal lengths -> J-shaped stomach
INTERIOR OF STOMACH
-smooth surface of gastricmucosa is reddish brown during life, except in the pyl
oric part, where it is pink
-when contracted -> gastric mucosa is thrown into longitudinal ridges called ga
stric folds or rugae; most marked toward the pyloric part & along the GC
-when swallowing -> formation of a temporary groove, the gastric canal, forms b/
n the longitudinal gastric folds along the LC; forms b/c of the firm attachment
of the mucosa to the muscular layer, which does NOT have an OBLIQUE LAYER at thi
s site; saliva & small quantities of food drain along the gastric canal to the p
yloric canal when the stomach is mostly EMPTY
RELATIONS OF STOMACH
-covered by VP except where BVs run along its curvatures & in a small area poste
rior to the cardial orifice
-ANTERIORLY, it is related to the DIAPHRAGM, LEFT LOBE OF LIVER, ANTERIOR ABDOMI
NAL WALL
-POSTERIORLY, to the OMENTAL BURSA, PANCREAS
-its posterior surface forms the anterior wall of the omental bursa
-INFERIORLY and LATERALLY to the transverse colon
-BED OF THE STOMACH, on w/c the stomach rests, is formed by the structures formi
ng the posterior wall of the omental bursa, from superior to inferior:
1. left dome of diaphragm
2. spleen
3. left kidney & suprarenal gland
4. splenic artery
5. pancreas
6. transverse mesocolon
VESSELS AND NERVES OF STOMACH
-RICH ARTERIAL SUPPLY:
>arises from the CELIAC TRUNK and its branches
>most blood is supplied by anastomoses formed along the LC & GC
>along the LC: by the right and left gastric arteries
>along the GC: by the right and left gastro-omental (gastro-epiploic) arteries
>fundus & upper body: short gastric artery, posterior gastric artery
-VEINS OF THE STOMACH
>parallel the arteries in position and course
>right & left gastric veins -> HPV
>short gastric vein & left gastro-omental vein -> splenic vein -> joins SMV -> H
PV
>right gastro-omental vein -> SMV
>pre-pyloric vein -> right gastric vein (important for surgeons in locating pylo
rus)
-LYMPHATIC DRAINAGE
-GASTRIC LYMPHATIC VESSELS accompany the arteries along the GC & LC; drains lymp
h from its ant & post surfaces towards it curvatures, where the GASTRIC LYMPH NO
DES and GASTRO-OMENTAL LYMPH NODES are located -> efferent vessels towards CELIA
C LYMPH NODES
>lymph from SUPERIOR 2/3 -> right and left gastric vessels -> GASTRIC LYMPH NODE
S; lymph from FUNDUS and SUPERIOR PART OF BODY -> PANCREATICOSPLENIC LYMPH NODES
>lymph from RIGHT 2/3 OF THE INFERIOR THIRD -> right gastro-omental vessels -> P
YLORIC LYMPH NODES
>lymph from the LEFT 1/3 OF THE GC -> PANCREATICODUODENAL LYMPH NODES
-INNERVATION
>parasympathetic nerve supply from the ant & post vagal trunks & their branches
>left vagus nerve -> anterior vagal trunk -> ant surface of esophagus -> LC -> g

ives off hepatic & duodenal branches -> the rest give rise to ant gastric branch
es
>right vagus nerve -> larger posterior vagal trunk -> post surface of esophagus
-> LC -> supplies branches to ant & post surfaces -> celiac branch: CELIAC PLEXU
S
>sympathetic nerve supply from T6 to T9 segments of spinal cord -> greater splan
chnic nerves -> CELIAC PLEXUS
SMALL INTESTINE
-primary site for absorption of nutrients
-from pylorus to ileocecal junction
DUODENUM
-L. breadth of 12 fingers
-first and SHORTEST (25cm) part of SI
-WIDEST and MOST FIXED part
-begins @ pylorus
-ends @ duodenojejunal flexure or junction (level of L2 vertebra), w/c usu takes
the form of an acute angle
-most of the duodenum is FIXED by peritoneum to structures on the posterior abdo
minal wall
-PARTIALLY RETROPERITONEAL
-4 parts:
1. superior part
>ampulla or duodenal cap: first 2 cm; has a MESENTERY; MOBILE
>distal 3cm and other parts of duodenum have NO MESENTERY and are IMMOBI
LE because they are RETROPERITONEAL
>ascends from pylorus; overlapped by liver & gallbladder
>has peritoneum in anterior aspect, but bare posteriorly EXCEPT for the
AMPULLA
>proximal part has the HEPATODUODENAL LIGAMENT attached SUPERIORLY and t
he GREATER OMENTUM attached INFERIORLY
2. descending part
>bile & main pancreatic ducts enter its posteromedial wall (usu unite to
form the hepatopancreatic ampulla w/c opens to the major duodenal papilla)
>ENTIRELY RETROPERITONEAL
>ant surface of proximal & distal thirds covered w/ peritoneum
>peritoneum reflects from middle third to form the transverse mesocolon
3. inferior or horizontal part
>passes over IVC, aorta, L3 vertebra
>crossed by the SMA & SMV & root of jejunum & ileum
4. ascending part
>curves anteriorly to join the jejunum at the duodenojejunal flexure, su
pported by the attachment of a suspensory muscle of the duodenum, the LIGAMENT O
F TREITZ (contraction -> widen angle of flexure ->facilitate movement of content
s)
-ARTERIAL SUPPLY
>arise from CELIAC TRUNK and SMA
>CELIAC TRUNK -> gastroduodenal artery -> superior pancreaticoduodenal artery ->
supplies DUODENUM PROXIMAL TO ENTRY OF BILE DUCT
>SMA -> inferior pancreaticoduodenal artery -> supplies DUODENUM DISTAL TO THE E
NTRY OF THE BILE DUCT
>pancreaticoduodenal arteries lie in the curve b/n the duodenum & head of pancre
as & SUPPLY BOTH
>The anastomosis of the superior and inferior pancreaticoduodenal arteries (i.e.
, between the celiac and superior mesenteric arteries) occurs between the entry
of the bile duct and the junction of the descending and inferior parts of the du
odenum. An important transition in the blood supply of the digestive tract occur
s here: proximally, extending orad(toward the mouth) to and including the abdomi
nal part of the esophagus, the blood is supplied to the digestive tract by

the celiac trunk; distally, extending ab orad(away from the mouth) to the left c
olic flexure, the blood is supplied by the SMA. The basis of this transition in
blood supply is embryological; this is the junction of the foregut and midgut.
-VENOUS DRAINAGE
>follow the arteries
>veins of duodenum follow the arteries & drain into the HPV, some directly, othe
rs indirectly via SMV & splenic veins
-LYMPHATIC DRAINAGE
>follow the arteries
>anterior lymphatic vessels -> pancreaticoduodenal lymph nodes and also to the p
yloric lymph nodes
>posterior lymphatic vessels -> superior mesenteric lymph nodes
>efferent lymphatic vessels from duodenal lymph nodes -> CELIAC LYMPH NODES
-INNERVATION
>nerves of duodenum derive from the vagus and greater & lesser splanchnic nerves
via celiac & superior mesenteric plexuses
JEJUNUM AND ILEUM
-jejunum begins @ duodenojejunal flexure where the GIT resumes an INTRAPERITONEA
L COURSE
-ileum ends @ ileocecal junction
-together, they are 6-7 m long; jejunum 2/5; ileum 3/5 of intraperitoneal sectio
n
-most of jejunum lies in LUQ of the infracolic compartment
-most of ileum lies in RLQ
-no clear demarcation line b/n jejunum & ileum
-the mesentery is a fan-shaped fold of peritoneum that attaches the jejunum & il
eum to the post abdominal wall
-root of mesentery directed obliquely, inferiorly, to the right from the duodeno
jejunal junction to the ileocolic junction
-ARTERIAL SUPPLY
>SMA -> jejunum & ileum via jejunal & ileal arteries
>arteries unite to form loops or arches called ARTERIAL ARCADES, which give rise
to straight arteries called VASA RECTA
-VENOUS DRAINAGE
>SMV drains jejunum & ileum
-LYMPHATIC DRAINAGE
>specialized lymphatic vessels in the villi that absorb fat are LACTEALS -> empt
y their milk-like fluid to lymphatic plexuses in walls of jejunum & ileum -> dra
in to lymphatic vessels in mesentery -> then through 3 grps of lymph nodes SEQUE
NTIALLY:
1. Juxta-intestinal lymph nodes: located close to the intestinal wall
2. Mesenteric lymph nodes: scattered among the arterial arcades
3. Superior central nodes: located along the proximal part of SMA
>efferent LVs from mesenteric lymp nodes -> superior mesenteric lymph nodes
>LVs from terminal ileum -> ileocolic lymph nodes
-INNERVATION
>SMA & branches surrounded by peri-arterial nerve plexus
>sympathetic fibers from T8-T10 segments of SC -> superior mesenteric nerve plex
us
>parasympathetic fibers from the posterior vagal trunks -> myenteric & submucosa
l plexuses
>sympathetic stimulation reduces paristaltic & secretory activity of intestine &
acts as a VASOCONSTRICTOR
>SI also has sensory/visceral afferent fibers
>intestine is INSENSITIVE to most pain stimuli but SENSITIVE to distension that
is perceived as COLIC (spasmodic abdominal pains or "intestinal cramps")
LARGE INTESTINE
-where water is absorbed from the indigestible residues of liquid chyme

-consist of the cecum, appendix, ascending, transverse, descending, sigmoid colo

n, rectum, anal canal
-can be distinguished from the SI by:
1. omental appendices
2. teniae coli: 3 distinct longitudinal bands; mesocolic (transverse & sigmoid m
esocolon attach); omental (omental appendices attach); free tenia (neither mesoc
olons nor omental appendices are attached)
3. haustra: sacculations of the wall of the colon b/n the teniae
4. much greater caliber
-teniae coli are thickened bands of smooth muscle, begin @ base of appendix, run
the length of the LI, abruptly broadening & merging w/ each other again at the
RECTOSIGMOID JUNCTION
CECUM AND APPENDIX
-1st part of LI
-continuous w/ ascending colon
-blind intestinal pouch
-lies in the iliac fossa of the RLQ of the abdomen
-if distended w/ feces/gas, cecum may be palpable thru anterolateral abdominal w
all
-almost entirely enveloped by peritoneum & can be LIFTED FREELY but NO MESENTERY
-may be displaced from the iliac fossa but bound to lateral abdominal wall via o
ne or more CECAL FOLDS of the peritoneum
-terminal ileum enters the cecum obliquely & partly invaginates into it
-ileal orifice enters the cecum b/n the ileocolic lips, folds that meet laterall
y to form ridges called frenula of the ileal orifice
-circular muscle is POORLY DEVELOPED around the orificel therefore, the valve i
s unlikely to have any sphincteric action
-orifice usually closed by tonic contraction of the ileal papilla on the cecal s
ide; papilla probably serves as a relatively passive flap valve, preventing refl
ux during contractions
-appendix is a blind intestinal diverticulum that contains masses of lymphoid ti
ssue w/ a MESO-APPENDIX MESENTERY (derived from the posterior part of the mesent
ery of the terminal ileum)
-position of appendix is variable, but usually retrocecal
-ARTERIAL SUPPLY OF CECUM
>SMA -> ileocolic artery
-ARTERIAL SUPPLY OF APPENDIX
>appendicular arery
-VENOUS DRAINAGE OF CECUM AND APPENDIX
>ileocolic vein
-LYMPHATIC DRAINAGE OF CECUM AND APPENDIX
-lymph nodes in the mesoappendix -> ileocolic lymph nodes
-INNERVATION
>sympathetic & parasympathetic nerves from superior mesenteric plexus
>sympathetic nerve fibers from lower thoracic part of SC
>parasympathetic nerve fibers from vagus nerves
COLON
-4 parts: ascending, transverse, descending, and sigmoid
-ascending colon
-right colic flexure or hepatic flexure
-ascending colon is SECONDARILY RETROPERITONEAL along the RIGHT SIDE OF THE POST
ERIOR ABDOMINAL WALL; usu covered by peritoneum anteriorly & on its sides but it
has a short mesentery on 25% of ppl
-AC is separated from the anterolateral abdominal wall by the GO
-right paracolic gutter: deep vertical groove lined w/ PP
The arterial supply to the ascending colon and right colic
flexureis from branches of the SMA, the ileocolicand right
colic arteries(Figs. 2.54 and 2.55; Table 2.10). These arteries anastomose with

each other and with the right branch

of the middle colic artery,the first of a series of anastomotic
arcades that is continued by the left colic and sigmoid arteries to form a conti
nuous arterial channel, the marginal
artery(juxtacolic artery). This artery parallels and extends
the length of the colon close to its mesenteric border.
-Venous drainage from the ascending colonflows through
tributaries of the SMV, the ileocolicand right colic veins
(Fig. 2.56A). The lymphatic drainagepasses fi rst to the epicolicand paracolic l
ymph nodes,next to the ileocolicand
intermediate right colic lymph nodes,and from them to
the superior mesenteric lymph nodes(Fig. 2.56B). The nerve
supply to the ascending colonis derived from the superior
mesenteric nerve plexus(Fig. 2.56C).
-transverse colon: third, longest, and most mobile part of the large intestine
-The
left colic flexure(splenic fl exure) is usually more superior,
more acute, and less mobile than the right colic flexure.; anterior to the infer
ior part of the left kidney and attaches to
the diaphragm through the phrenicocolic ligament
-The arterial supply of the transverse colonis mainly from
the middle colic artery(Figs. 2.54 and 2.55; Table 2.10), a
branch of the SMA. However, the transverse colon may also
receive arterial blood from the rightand left colic arteriesvia
anastomoses, part of the series of anastomotic arcades that
collectively form the marginal artery (juxtacolic artery).
Venous drainage of the transverse colonis through the
SMV (Fig. 2.56A). The lymphatic drainageof the transverse
colon is to the middle colic lymph nodes,which in turn
drain to the superior mesenteric lymph nodes(Fig. 2.56B).
The nerve supply of the transverse colonis from the superior mesenteric nerve pl
exusvia the peri-arterial plexuses of
the right and middle colic arteries (Fig. 2.56C). These nerves
transmit sympathetic, parasympathetic (vagal), and visceral
afferent nerve fibers
-descending colon: secondarily retroperitoneal position between the left colic f
l exure and the
left iliac fossa, where it is continuous with the sigmoid colon
(Fig. 2.52). Thus, peritoneum covers the colon anteriorly
and laterally and binds it to the posterior abdominal wall.
Although retroperitoneal, the descending colon, especially in
the iliac fossa, has a short mesentery in approximately 33% of
people;
-The sigmoid colon extends from the iliac fossa to
the third sacral (S3) vertebra, where it joins the rectum. The
termination of the teniae coli, approximately 15 cm from the
anus, indicates the rectosigmoid junction.
-The sigmoid colon usually has a long mesentery the sigmoid mesocolon and therefore
has considerable freedom of
movement, especially its middle part.
-The arterial supply of the descending and sigmoid colon
is from the left colicand sigmoid arteries
-at
approximately the left colic fl exure, a second transition occurs
in the blood supply of the abdominal part of the alimentary
canal: the SMA supplying blood to that part orad (proximal)
to the fl exure (derived from the embryonic mid gut), and the
IMA supplying blood to the part aborad (distal) to the flexure
(derived from the embryonic hindgut). The sigmoid arteries
descend obliquely to the left, where they divide into ascending and descending b

ranches. The superior branch of the

most superior sigmoid artery anastomoses with the descending branch of the left
colic artery, thereby forming a part of the
marginal artery. Venous drain age from the descending colon
and sigmoid colonis provided by the inferior mesenteric vein,
flowing usually into the splenic vein and then the hepatic portal vein on its wa
y to the liver (see Figs. 2.56A and 2.75B).
Lymphatic drainage from the descending colon and sigmoid colonis conducted throu
gh vessels passing to the epicolic and paracolic nodes, and then through the int
ermediate
colic lymph nodesalong the left colic artery (Fig. 2.56B).
Lymph from these nodes passes to the inferior mesenteric
lymph nodesthat lie around the IMA. However, lymph
from the left colic fl exure may also drain to the superior mesenteric lymph nod
es.
RECTUM AND ANAL CANAL
-The rectumis the fi xed (primarily retroperitoneal and subperitoneal) terminal
part of the large intestine. It is continuous with the sigmoid colon at the leve
l of S3 vertebra.