1 Department of Anatomy Digestive system – Part I MUDr. Marek Joukal, Ph.D. Digestive system functions: • food intake • mechanical and chemical processes • absorption of substances • excretion of the wasting products and useless remains Digestive system strucrture: Digestive tube: • oral cavity • pharynx • oesophagus • stomach • small intestine • large intestine Glands: • liver • pancreas Oral cavity – cavitas oris Borders: Rima oris Isthmus faucium Lips, buccae Palatum Diaphragma oris Content: Tongue Teeth CAVITAS ORIS cavum oris propriumvestibulum oris Vestibulum oris Fornix vestibuli sup. (frenulum labii sup.) Fornix vestibuli inf. (frenulum labii inf.) Tremata Trigonum retromolare Papilla parotidea 2 Lips (labia oris) and cheek (bucca, mala) Sulcus nasolabialis et mentolabialis Philtrum, tuberculum labii sup. Corpus adiposum buccae Frenulum labii superioris Frenulum labii inferioris Glandulae labiales at buccales Papilla parotidea Proper oral cavity Borders: Teeth Isthmus faucium Palatum Diaphragma oris Palatum durum Papilla incisiva (dustus incisivi, nervus nasopalatinus) Plicae palatinae transversae Glandulae palatinae Soft palate m. tensor veli palatini m. levator veli palatini Uvula palatina Aponeurosis palatina Muscles of the soft palate Muscles of the soft palate Musculus tensor veli apalatini O: scaphoid fossa, lateral plate of the auditory tube cartilage, spina ossis spenoidalis I: palatine aponeurosis F: elevation and tension of the soft palate In: Nervus mandibularis (CN V3) Musculus levator veli palatini O: inferior surface of the pars petrosa I: Palatine aponeurosis F: Elevation of the soft palate In: Pharyngeal plexus 3 Muscles of the soft palate Musculus palatoglossus O: palatine aponeurosis I: lateral margine of the tongue F: elevation of the root of the tongue In: plexus pharyngeus Musculus palatopharyngeus O: palatine aponeurosis I: lateral wall of the pharynx F: Elevation of the pharynx In: plexus pharyngeus Musculus uvulae O: palatine aponeurosis I: mucosa of the uvula F: elevation and retraction of the uvula In: plexus pharyngeus Diaphragma oris Musculus geniohyoideus Musculus mylohyoideus Sublingual gland Tongue Sublingual fold and caruncle Tongue (lingua, glossa) 1. Pars oralis (corpus, apex) 2. Pars pharyngea (radix) Radix linguae Corpus linguae Apex linguae Sulcus terminalis Sulcus medianus Foramen caecum Margines linguae Dorsum linguae Papillae filiformes Papillae fungiformes Papillae foliatae Papillae vallatae Inferior surface of the tongue Plica fimbriata Plica sublingualis Frenulum linguae 4 Musculus genioglossus O: spina mentalis I: aponeurosis linguae F: pulls the tongue anteriorly Extraglossal muscles Musculus hyoglossus O:greater horn of the hyoid bone I: lateral margine of the tongue F:pulls the tongue downwards and backwards Musculus styloglossus O: styloid proces I: lateral margine of the tongue F: pulls the tongue backwards and upwards Musculus palatoglossus Intraglossal muscles M. longitudinalis sup. et inf. M. transversus linguae M. verticalis linguae Gingiva Alveolar mucous membrane Gingiva marginalis et alveolaris (paramarginal line) Papillae gingivales, gingivodental closure, sulcus gingivalis Teeth (dentes) Decidous teeth Adult (permanent) teeth Heterodont teeth: • Dentes incisivi (incisors) • Dentes canini (canines) • Dentes praemolares (premolars) •Dentes molares (molars) 5 Arcus dentalis superior (half of elipse) Arcus dentalis inferior (parabola) Facies occlusalis - tubercula dentalia - margo incisalis Facies approximales - f. mesialis (prox.) - f. distalis Facies vestibularis - f. labialis - f. buccalis Facies oralis - f. palatina - f. lingualis Fixation of the teeth: Type:Gomphosis Periodontium (fixative ligaments): (apical, alveolar, transseptal, gingival) Parodontium: all of the fixative structures of the tooth (periost, periodontium, cementum, gingiva) Incisors Canines Premolars 6 Molars Dental formula Tooth eruption - primary teeth Sequence: First incisor (6 months) Second incisor First molar Canin Second molar (2-2,5 yrs) Eruption – adult teeth Sequence: First incisor, first molar Second incisor First premolar Canine Second molar Second premolar Third molar Salivary glands GLANDULAE SALIVARIAE MINORES glandulae labiales glandulae buccales glandulae palatinae glandulae linguales GLANDULAE SALIVARIAE MAJORES glandula parotidea glandula submandibularis glandula sublingualis 7 GLANDULA PAROTIDEA Monostomatic Serous Lobus superficialis Lobus profundus Nervus facialis Ductus parotideus Glandula parotidea accesoria GLANDULA SUBMANDIBULARIS Monostomatic Seromucinous Arteria et vena facialis Ductus submandibularis Ductus submandibularis Nervus lingualis Caruncula sublingualis GLANDULA SUBLINGUALIS Polystomatic Ductus sublingualis major Ductus sublinguales minores (20) Plica sublingualis Caruncula sublingualis Base of skull – C6 Pars nasalis (choanae) Pars oralis (isthmus faucium) Pars laryngea (aditus laryngis) cavum pharyngis fornix pharyngis Pharynx 8 RECESSUS PHARYNGEUS FASCIA PHARYNGOBASILARIS (Luschke´s space) CHOANAE FORNIX PHARYNGIS TONSILLA PHARYNGEA HYPOPHYSIS PHARYNGIS OSTIUM PHARYNGEUM TUBAE AUDITIVAE: TORUS TUBARIUS (PLICA SALPINGOPHARYNGEA) TORUS LEVATORIUS PLICA SALPINGOPALATINA TONSILLA TUBARIA PARS NASALIS PHARYNGIS nasopharynx, epipharynx Waldeyer´s lympho-epithelial ring Tonsilla pharyngea Tonsillae tubariae Tonsilae palatinae Tonsilla lingualis PARS ORALIS PHARYNGIS (oropharynx) Isthmus faucium: palatum mole arcus palatoglossus arcus palatopharyngeus tonsilla palatina radix lingue PARS LARYNGEA PHARYNGIS (laryngo- , hypopharynx) Aditus laryngis: epiglottis plicae aryepiglotticae tuberculum cuneiforme tuberculum corniculatum plica interarytaenoidea (during respiration) insisura interarytaenoidea (during fonation) M. CONSTRICTOR PHARYNGIS SUP. M. CONSTRICTOR PHARYNGIS MEDIUS M. CONSTRICTOR PHARYNGIS INF. RAPHE PHARYNGIS CONSTRICTORES PHARYNGIS 9 CONSTRICTORES PHARYNGIS M. CONSTRICTOR PHAR. SUP. PARS PTERYGOPHARYNGEA BUCCOPHARYNGEA MYLOPHARYNGEA GLOSSOPHARYNGEA M. CONSTRICTOR PHAR. MED.: PARS CHONDROPHARYNGEA CERATOPHARYNGEA M. CONSTRICTOR PHAR. INF.: PARS THYROPHARYNGEA CRICOPHARYNGEA M. STYLOPHARYNGEUS (proc. styloideus) M. SALPINGOPHARYNGEUS (tuba auditiva) M. PALATOPHARYNGEUS (aponeurosis palatina) LEVATORES PHARYNGIS OESOPHAGUS Ostium cardiacum: adult 40 cm from inferior incisors Newborn approx. 14 cm (C6 - Th11) pars abdominalis C6 Th4 Th11 pars cervicalis pars thoracica pars retrotrachealis et retropericardiaca Mucous membrane JUNCTION GASTROOESOPHAGEALIS LONGITUDINAL FOLDS Submucosal tissue GL. OESOPHAGEAE PLEXUS SUBMUCOSUS Muscular tissue upper 1/3 striated lower 1/3 smooth (circular, longitudinal) External layer ADVENTITIA SEROSA – pars abd. ESOPHAGOGRAPHY 10 Stomach Cardia Fundus (fornix) Corpus ventriculi Pars pylorica Pylorus Paries anterior Paries posterior Curvatura major Curvatura minor Incisura cardiaca Incisura angularis Shape of the stomach • Ostium cardiacum • Fornix ventriculi (air bubble) • Pars cardiaca • Canalis gastricus • Pars pylorica Antrum pyloricum (sinus gastricus) Canalis pyloricus Ostium pyloricum Stomach cavity Plicae gastricae Sulcus salivarius Areae gastricae Foveolae gastricae Glandulae gastricae Succus gastricus (0,5% HCl) Gastrin Chymus TUNICA MUCOSA VENTRICULI Fibrae obliquae Stratum circulare (m. sphincter pylori) Stratum longitudinale (taenia curvaturae majoris et minoris) TUNICA MUSCULARIS VENTRICULI Omentum minus lig. hepatoduodenale lig. hepatogastricum Omentum majus lig. gastrocolicum Lig. gastrolienale (lig. splenicogastricum) TUNICA EXTERNA VENTRICULI (visceral peritoneum) 11 regio hypochondriaca sin. cardia – left from Th11-12 pylorus – right from L1-2 Labbe´s triangle Traube´s semilunar space Pars digestoria (incisura angularis) Pars egestoria GASTROGRAPHY References: Putz, R. (2008): Atlas of Human Anatomy Sobotta. Elsevier Books. Keith L. Moore, Arthur F. Dalley (2005): Clinically Oriented Anatomy. Williams and Wilkins. Platzer, W., Kahle, W., Leonhardt H. (1992): Locomotor system. Georg Thieme Verlag, Stuttgart, New York, 4th edition. Čihák, R. (1987): Anatomie 1. Avicenum, Zdravotnické nakladatelství. Netter, F. H. (1997): Interactive Atlas of Clinical Anatomy. Novartis, USA.