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Anatomy

1. Digestive anatomy

2. introduction

3. The system which helps in digestion of food by that, food been metabolized and converted into energy for living.

4. The parts of the digestive system 1. Mouth. 2. Pharynx 3. Esophagus 4. Stomach 5. Small intestine - duodenum, jejunum and ileum. 6. Large intestine- caecum , appendix, ascending colon, transverse colon, descending colon and sigmoid colon. 7. Rectum 8. Anal canal.

5. peritoneum

6. . Abdomen contains various organs which enclosed by the covering called peritoneum. The peritoneum has two layers namely, outer parietal layer and inner visceral layer. In between these two layers, the peritoneal cavity is present which contain the peritoneal fluid.

7. Visceral peritoneum The inner visceral layer is adherent & inseparable to organs which limits the movements of the visceral organs during various activities

8. Police man of abdomen . The peritoneal fluid contains numerous lymphocytes which protect the visceral organs from the pathogenic agents. Hence, peritoneum is considered as "policeman of abdomen".

9. Paeital peritoneum This has several somatic nerve fibers. This is lines the inner surface of the abdominal and pelvic wall. The space inside the parietal peritoneum is named as greater sac and is filled with peritoneal fluid.

10. Functions of peritoneum 1. Movement of visceral organs 2. Protection from the pathogenic organisms 3. Absorption and dialysis 4. Storage of fat.

11. Folds of peritoneum To mobilize the organ, the peritoneum is modified into several folding known as folding of peritoneum.

12. omentum Greater omentum ( Omentum - outer covering) This is a large fold that hang over from the greater curvature of stomach and entirely covers the abdominal cavity. Lesser omentum These fold which cover the lesser curvature of stomach, first & second part of duodenum

13. Mesentery This is a modified visceral peritoneal fold which covers the small intestine. This is fan shaped and makes the suspension of jejunum and ileum.

14. Periotoneal lining in large intestine Meso -appendix This makes the suspension of the vermiform appendix. Mesocolon This is the fold of peritoneum which cover large colon in various modified forms namely, 1. Transverse mesocolon - helps the suspension of the transverse colon 2. Sigmoid mesocolon - helps the suspension of the sigmoid colon.

15. Peritoneal cavity Peritoneal cavity is space between visceral and parietal peritoneum and contains peritoneal fluid.

16. Applied anatomy Collection of fluid in peritoneal cavity is called ascites . This is commonly seen in cirrhosis of liver. Aspiration of the fluid from the peritoneal cavity is called paracentesis . Inflammation of peritoneum is called peritonitis.

17. Quadrants of abdomen To understand the abdominal structures, the abdomen is divided into the nine quandrants by drawing four imaginary lines namely, 1. Two horizontal planes 2. Two vertical planes

18. the nine regions are, 1. Right hypochondrium 2. Epigastrium 3. Left hypochondrium 4. Right lumbar 5. Umbilical 6. Left lumbar 7. Right iliac 8. Hypogastrium 9. Left iliac

19. Oral cavity

20. The oral cavity is the first anterior opening of the alimentary canal. This present in the inferior part of the face which is guarded by lips. The oral cavity is divided into two parts namely, 1. Vestibule of mouth 2. Oral cavity proper.  

21. lips The lips has fleshy part with outer and inner margins. The outer margin is formed by the skin and inner margin is lined by the mucosal layers . The junction between skin and mucosal part of lip called muco-cutaneous junction

22. Formation of lips 1. Skin 2. Superficial fascia 3. Orbicularis oris muscle 4. Submucosa has the lymph, and vessels 5. Mucosal layer

23. Oral cavity proper This is the cavity of mouth help to grain the food in proper form. The oral cavity has anterior opening of mouth which is the two lips, posterior opening is guarded by oro -pharyngeal isthmus.

24. boundaries of oral cavity Roof of mouth is formed by palate Floor has body of tongue, lower rows of teeth, gingivo -lingual sulcus . (The space between tongue and gum), gingivo -labial sulcus or vestibule of mouth. (The space between the gum and lip) The lateral wall of mouth which form cheeks.

25. Formation of cheecks skin buccal pad of fat with connective tissue Buccinator muscle Bucco -pharyngeal membrane Buccal mucosa

26. GUMS Gums are the soft dense fibrous connective tissue which helps to place a tooth in position. This covers over the neck and root of the teeth. Gums has two parts in each tooth namely, Free part Attached part

27. Applied aspects Koplick's spot : This is seen in measles and is a diagnostic spot There is grayish white spot seen in region of opening of parotid gland

28. TEETH Teeth is the hardest structure in our body which is helpful for grinding of food and convert it into bolus. In adults, teeth are 32 in number 16 in upper rows and 16 in lower rows. Arrangement is converted a dental formula 3, 2, 1, 2/2,1, 2, 3 in both upper and lower rows.

29. four types of teeth 1. Incisor-2 2. Canine-1 3. Premolar-2 4. Molar.-3

30. Parts of individual teeth 1. Upper crown 2. Middle- neck 3. Lower root

31. enamel Crown has smooth hardest connective tissue in our body is called enamel which is the modification of the bone. Lower to the enamel the structure is called cementum . The cementum is extending downwards and connected to root of teeth. The cementum holds teeth into the socket of the alveolar arch.

32. dentine Inner to the enamel, the soft highly calcified part dentine structure is present. The cementum is a structure seen inferior to the dentine.

33. Applied anatomy Scurvy, the swollen spongy and bleeding gums while brushing, due to the deficiency of vitamin C Improper oral hygiene cause decalcification of enamel, dentine and softening of bone is called dental caries. Inflammation of buccal mucosa of oral cavity is called stomatitis and ulcer formation over the buccal known as apthous ulcer due to nutritional deficiency.

34. tongue

35. Tongue is a mobile muscular organ, helpful for phonation, swallowing, chewing and taste perception. This is situated in the floor of the mouth.

36. structure 1. Root 2. Body 3. Tip.

37. parts 1. Oral part 2. Pharyngeal part.

38. Root The root of the tongue is attached with nearby bones by its extrinsic muscles and makes it to fix with the floor of mouth.

39. The body is flattened and has dorsal and ventral surface The ventral surface is related with the floor of mouth The dorsal surface is visible part of the tongue which divided into anterior 2/3 and posterior 1/3 and separated by a V shaped impression named " sulcus terminalis

40. The anterior part further divided into right and left half by a median sulcus . In the meeting point of the sulcus terminalis and median sulcus , a depression seen called foramen caecum . The whole surface of the dorsum of tongue is rough in nature because of the finger like processes named papillae

41. 1. Circumvallate papillae 2. Fungi form papillae 3. Filiform papillae 4. Folate papillae.

42. tip The tip of the tongue is U shaped, the free margin seen behind the lower rows of teeth. The space between tongue and teeth is gingivo -lingual sulcus .

43. Pharyngeal part The pharyngeal part of tongue or root of tongue is forming oro -pharyngeal isthmus in this two foldings seen 1. palato-glossal fold 2. palato -pharyngeal fold Between the two foldings , the palatine tonsil present.

44. Intrinsic muscles : 1. Superior longitudinal 2. Inferior longitudinal 3. Transverse 4. Vertical. Extrinsic muscles 1. Genioglossus 2. Hyoglossus 3. Styloglossus and 4. Palatoglossus .

45. Arterial Supply Lingual artery , tonsillar artery Venous Drainage : Deep lingual vein which drains into facial vein. Lymphatic Drainage Submental nodes from tip.

46. Nerve Supply Motor supply by hypoglossal nerve which supplies all intrinsic and extrinsic muscles of tongue except palatoglossus , palatoglossus is by vago accessory complex. Sensory supply by 1. Lingual nerve - anterior 2/3. 2. Glossopharyngeal nerve - posterior 1/3 Special sensory ( taste perception by) Chorda tympani from anterior 2/3. glossopharyngeal from posterior 1/3 vagus from posterior most part.

47. Applied aspects Glossitis is the inflammation or ulceration of the tongue Jaundice can perceived by having the undersurface of tongue. In unconscious person, the tongue will fall backwards and block the air way. To avoid this head should tilted and tongue should moves out manually.

48. palate

49. palate The roof of the mouth is called palate and has two parts namely, 1. Soft palate 2. Hard palate

50. Hard palate Hard palate is formed by the palatine process of maxilla and palatine bones. The two palatine bones are united by inter palatine suture..

51. Soft Palate The soft palate is forming by posterior one- third of roof of mouth. This is a musculo aponeurotic structure. The palatine aponeurosis is forming by the frame work of the soft palate. Above and below to the aponeurosis , the muscles are present

52. Importance Soft palate regulates the opening of the nasal cavity and oral cavity. The naso -pharyngeal isthmus is between the nasopharynx and oro -pharynx. The oro -pharyngeal isthmus is between the oral cavity and oro -pharynx.

53. External features 1. Two surfaces - anterior/ inferior surface and posterior or superior surface. 2. Two borders - upper or anterior border and lower or posterior border.

54. muscles of soft palate Musculus uvulae Palato - glossus Palato - pharyngeus Tensor veli palatini Levator veli palatini

55. Blood supply The soft palate is supplied by the greater palatine artery, spheno - palatine artery, palatine branch of facial artery and maxillary artery.

56. Nerve supply By pharyngeal plexus of nerve all the muscle are supplied by the pharyngeal branch of vagus . The exception is tensor veli palatini and is supplied by the medial pterygoid branch of mandibular division of trigeminal nerve. The soft palate has some taste buds are supplied by the glosso -pharyngeal nerve and by the fibers of vagus .

57. Applied aspects Cleft palate is a congenital condition, by the non-fusion of right and left palatine process. It can be reconstructed by the surgical procedures.

58. Salivary gland

59. The salivary gland secretes the saliva which is helpful for the lubrication mouth and mastication. This partly digest the food and convert it into bolus

60. 1. Parotid gland 2. Sub mandibular gland 3. Sublingual gland.

61. Parotid Gland This is a largest salivary gland which secretes the serous saliva. The 90% of the saliva is secreted by the parotid gland.

62. Site and situation The parotid gland is situated in the antero - inferior part of the external ear. Size and shape This is a three sided inverted pyramidal shaped structure. This has an apex which facing downwards. The gland is totally 15 to 30 grams of weight.

63. Covering of the parotid gland The parotid gland is covered by the extension of the deep cervical fascia which is called parotid fascia. This is tightly present.

64. Borders This has three borders 1. Anterior border 2. Posterior border 3. Medial border. Surfaces 1. Lateral surface or superficial surface 2. Antero- medial surface 3. Postero - medial surface. The gland has apex and base.

65. lobes Larger superficial lobe Smaller deep lobe. In between the two lobes the following structures are passing 1. External carotid artery and its branches, 2. Formation and division of retro mandibular vein, 3. Termination of the facial nerve and its branches

66. Parotid duct The duct which arises from the parotid gland has 4 cms of length. This pierces the lateral wall of mouth and opens into the vestibule of mouth

67. Blood supply This is supplied by the branches of external carotid artery. The venous drainage by the internal jugular vein Nerve supply This is supplied by the auriculo -temporal nerve.

68. Applied aspects Mumps is caused due to viral infection commonly seen in children. Parotid abscess by spreading of infection through the parotid duct.

69. submandibular Salivary Gland This is second largest salivary gland present in the submandibular region in the floor of mouth. This secretes both serous and mucus saliva

70. Site and situation This is situated in the submandibular fossa of mandible. 'J' shaped gland having the larger deep part and small superficial part.

71. Relation Superficial 1. Skin 2. Superficial fascia 3. Deep fascia. Deep Hyoglossus Genioglossus Medial Submandibular ganglion. Lateral Mandible Medial pterygoid Facial artery

72. Blood supply : It is supplied by the facial artery and facial vein Nerve supply : It is supplied by the submandibular ganglion.

73. Duct The submandibular salivary duct is also known as wharton's duct.

74. Sublingual Salivary Gland This is small salivary gland present in the floor of the mouth and covered by the mucosa of the mouth. This is present near the sublingual fossa of the mandible and over the mylohyoid muscles. Duct of rinivus The sublingual gland duct is duct of rinivus . The sublingual salivary gland secretes the mucous saliva .

75. pharynx

76. Pharynx is a musculo - tubular structure which is the common pathway for food and air. This is seen behind the nasal cavity, oral cavity and larynx. This is about 10 cms in length. .

77. parts 1. Upper naso - pharynx 2. Middle oro - pharynx 3. Lower laryngo - pharynx

78. boundaries Superior : base of skull Inferior : This continues anteriorly with larynx and posteriorly with oesophagus

79. Nasopharynx The nasopharynx is the upper part of the pharynx. This is the pathway for air. This has, anteriorly -Nasal cavity and it's opening (posterior nasal aperture) 2. posteriorly - atlas and part of axis. 3. superiorly -Base of skull formed by the body of the splenoidal bone 4.Inferiorly- continues with oro -pharynx

80. Passavants ridge Passavants ridge is the muscular ridge present in the posterior part of the naso -pharyngeal isthmus. The ridge is helpful for the opening and closure of the naso -pharyngeal isthmus associated with the soft palate.

81. Oro-pharynx This is a part of the pharynx seen behind the oral cavity. This is bounded by, 1. Anteriorly - oral cavity and oro -pharyngeal isthmus. 2. Posteriorly - body of C2,C3 and C4 vertebrae. 3. Laterally - palato-glossal fold and palato-pharyngeous fold seen.

82. Laryngo -pharynx The part of pharynx seen behind the larynx. This is pathway for food alone. Superiorly - oro -pharynx Inferiorly - pharygo-oesophageal junction. Posteriorly - C5 and C6 vertebra. Anteriorly - inlet of larynx and related with the cricoid cartilage. Laterally - a small depression is present called pyriform fossa .

83. Wall of pharynx Pharynx is the musculo - tubular structure. This has four layers, 1. Mucosal layer 2. Submucosa 3. Muscular layer 4. Serous layer

84. Blood supply Pharynx is supplied by the, ascending palatine artery Tonsillar branch of facial artery

85. Applied aspects Inflammation of pharynx is pharyngitis . Difficulty in swallowing is known as dysphagia

86. Eutachian tube   This is a osso - cartilaginous tube arises from the middle ear cavity. This extends from middle ear to naso -pharynx. This has bony part and cartilaginous part. Functionally it equalizes the pressure in the middle ear cavity.

87. Bony part The outer bony part present over the petrous part of the temporal bone Cartilaginous part This is anterior and present in a greater wing of the sphenoidal bone

88. Blood supply : Pharyngeal artery of the pterygoid canal. Nerve supply : Pterygo -palatine ganglion.

89. Applied aspects Infection can transfer from throat to middle ear via auditory tube. Inflammation of auditory tube is called Eustachian catarrh

90. esophagus Esophagus is a musculo - tubular structure called as food pipe which connects pharynx with stomach.

91. This has 25cms of length the upper end is attached with pharynx seen at the level of C6 vertebra. The lower end connected with cardiac opening of stomach at the level of T 11 vertebra

92. Constrictions 1. At the pharyngo -esophageal junction 2. At the bifurcation of trachea 3. By the arch of aorta 4. While passing through the diaphragm.  

93. relation Anteriorly - related with trachea,Arch of aorta and it's branches, recurrent laryngeal nerve and phrenic nerve . Pericardium and heart in the inferior mediastinum Posteriorly , in the neck region related with cervical vertebrae and in thoracic region related with thoracic vertebrae.

94. Blood supply Cervical part is supplied by inferior thyroid artery. Thoracic part is supplied by esophageal branch of aorta abdominal part is supplied by left gastric artery. Nerve supply By Autonomic nervous system

95. Internal features The esophagus has inner mucosal layer, submucosal layer, muscular layer outer serous layer.

96. Applied aspects The ulceration or inflammation of esophagus is more common in lower end due to regurgitation of acid from stomach. Hiatus hernia is occur in esophageal opening

97. stomach

98. Stomach is a muscular bag like structure which is the temporary reservoir of food.

99. Site and situation This is situated in the abdominal cavity occupying epigastrium and left hypochondrium . Size and shape This is a J shaped structure having 25cms of length and the capacity of 1.5 litres .

100. External features 2 borders 2 surfaces 2 curvatures 2 sphincters 2 openings 2 parts

101. Two borders : superior border and inferior border Two surfaces : anterior surface and posterior surface Two curvature : the greater curvature, lesser curvature

102. Two sphincters The cardiac opening of stomach is guarded by cardiac sphincters Pyloric sphincter : This is seen in pyloric end of stomach

103. Covering of stomach The visceral peritoneal covering of stomach is called omentum . The part of omentum attached with the lesser curvature of stomach is called the lesser omentum . One which attached with greater curvature of stomach called as greater omentum

104. Visceral relation Anteriorly - anterior abdominal wall, diaphragm, inferior surface of liver 2.Posteriorly - duodenum, pancreas, spleen, inferior vena cava, transverse colon and transverse mesocolon .

105. Internal features The interior of stomach is lined by mucosal layer which has longitudinal mucosal fold called as gastric rugae . Inside the gastric rugae , gastric pit's seen. The gastric pits has gastric glands which secretes gastric juice which contains HCL, pepsin, rennin, lipase.

106. Blood supply left gastric artery, gastro duodenal artery, superior epigastric artery and pancreatico - duodenal artery. Nerve supply Sympathetic from T6 to T10 and parasympathetic from vagus nerve.

107. Applied aspects The peptic ulcer occurs in the pyloric region and first part of duodenum due to over secretion of the hydrochloric acid. Gastric ulcer is occurs in lesser curvature of the stomach. H. Pylori are the common causative organism of gastric ulcer.

108. intestine

109. Intestine is the longest and narrow part in the digestive tract. Functionally, it is the main site for digestion and absorption of all metabolic products from the food. This intestine is present in the middle and lower part of the abdominal cavity.

110. Divisions of intestine 1. Proximal - small intestine or bowel This has duodenum, jejunum and ileum. 2. Distal- large intestine or colon (fig 3.22) Large intestine consist of caecum , appendix, ascending colon, transverse colon, descending colon and sigmoid colon

111. duodenum Duodenum is the first part of the small intestine. This is the tube which has numerous glands which converts the acid chyme into alkaline medium. The absorption of the digestive material is starts from the duodenum.

112. Site and situation Duodenum is located 2.5cm above to the umbilicus The duodenum is present in L1, L2, L3 vertebral level. This is the tube present in the retro-peritoneum. Size and shape This is a "C" shaped structure has 25cms of length. This is a widest and shortest tube in the small intestine.

113. Divisions of duodenum The duodenum further divided into the four parts according to the C shape. 1. First part- superior part-5cms of length. 2.Second part - descending part- 7.5cms of length 3.Third part - horizontal part -10cms 4.Fourth part- ascending part- 2.5cms

114. opening Upper opening is connected with pyloric end of stomach and guarded by pyloric sphincter Lower opening is connected with jejunum and named as duodeno - jejunal junction

115. relations Anterior Liver and gall bladder Transverse colon Small intestine Stomach Lesser omentum .

116. . Posterior Portal vein Bile duct Right kidney and ureter Inferior vena cava Psoas major muscle. Medial Head and uncinate process of pancreas Bile duct Lateral Hepatic flexure of colon. Inferior Coils of jejunum.  

117. Applied aspects Meckel's diverticulum : This cause intestinal obstruction. Acute inflammation of diverticulosis cause pain like that or in appendicitis.    

118. Jejunum  Jejunum is the continuation of duodenum from duodeno-jejunal junction and continuous with ileum. The inner surface of jejunum has numerous villai and more absorption take place here.

119. Ileum Ileum is the continuation of jejunum and ends with caecum at ileo-caecal junction. The whole length is nearly 6metres and has the visceral peritoneal covering of mesentry .

120. Large intestine

121. Modifications of large intestine Taeniae coli Appendices epiploicae . Sacculations

122. Caecum Caecum is the "saucer" shaped structure having 6 cm of width and 5cm of length. Site and situation It is situated in the right iliac region over the iliacus and iliac fascia.

123. External features When looking externally, this is divided into 3 types, based on it's shape, 1. Conical shaped 2. Ampulatory 3. Intermediary

124. Openings This has three openings Upper opening which is connected with ascending colon. The opening of appendix is guarded by appendicular valve Opening of ileum guarded by ileo-caecal valve

125. Applied aspects Ameobic dysentery caused by Entameoba histolytica which commonly produce ulceration in caecum . Inflammation of caecum is called caecitis .

126. Ascending colon ascending colon is the ascending continuation of large intestine and has 12.5 Cms of length. Inferiorly connected with caecum . Superiorly continuous as transverse colon just inferior to the liver and makes a deep curvature called hepatic flexure

127. Transverse colon This is the continuation of ascending colon seen transversely and pendulous in nature. In the right, this is connected with ascending colon at hepatic flexure. In the left, this is connected with descending colon at splenic flexure. This has 50cms of length.

128. Descending colon Descending colon is the descending continuation of large intestine. This begins from the splenic flexure passes vertically continuous with sigmoid colon at the left hypogastrium . This has 25cms of length.

129. Sigmoid colon This is an S shaped seen between descending colon and rectum. This is held in position by visceral peritoneal covering of sigmoid mesocolon . This has 37.5 cms of length.

130. appendix This is a small worm like structure seen in the right iliac region. Seen near to the ileo-caecal junction. This has 2-20cms of length. Usually very long in children but it is narrow and shorter in adults.

131. positions Paracolic Retro colic Para umblical Promonteric Pelvic Sub caecal

132. Blood supply : Appendicular artery which is the branch of superior mesenteric artery. Nerve supply 1. Sympathetic supply by the T9, T10. 2. Parasympathetic from the vagus nerve. Lymphatic drainage : Ileo -colic nodes.

133. Applied asoec Inflammation of appendix is called appendicitis. Pain and tenderness of appendicitis is noted in a region known as Mc Burney's point (It drawn between anterior superior iliac spine and umbilicus)

134. rectum distal part of the large intestine unites with a comparatively straight structure called rectum. The Taeniae -coli and sacculations are absent in the rectum.

135. Site and situation This is seen in the pelvic cavity behind the uterus in female and urinary bladder in males. Seen infront of the sacrum.

136. Extension This is the continuation of the sigmoid colon at recto-sigmoid junction. Inferiorly connected with the anal canal by the ano -rectal junction. Size and shape The rectum is 12 cm in long. The lower dilated part is called rectal ampulla .

137. Course Rectum runs from the sigmoidal colon and runs downwards and backwards at first, then runs downwards forwards at second, then runs backwards and connect with anal canal. Totally, there are two anterio -posterior curvature.

138. 3 lateral curvatures 1. Superior lateral curvature 2. Middle lateral curvature 3. Inferior lateral curvature

139. Internal Features (Mucosal folds) The interior of rectum has mucosa. The mucosal fold in rectum are transverse folds called plica semilunaris . The longitudinal folds present in the lower part of rectum, and the transverse folds namely, first, second, third and fourth transverse folds.

140. Arterial supply 1 . Superior rectal artery 2. Middle rectal artery 3. Inferior rectal artery. Venous drainage 1 . Superior rectal vein 2. Middle rectal vein 3. Inferior rectal vein.

141. Lymphatic drainage 1 . Upper half is drain into the inferior mesenteric node 2. Lower half is drain into the internal iliac node. Nerve supply 1 . Sympathetic from the L1 and L2. 2. Parasympathetic from the S2,S3 and S4.

142. Support of rectum 1 . Pelvic floor muscles 2. Fascia of waldeyar's 3. Recto vesical pouch 4. Pelvic peritoneum 5. Perineal body.

143. Applied anatomy Prolapse of rectum: mucosal prolapse of rectum is commonly seen in children due to violent straining during defecation . In sometimes, the whole length of the rectum will prolapsed called procidentia . (rectal prolapse )

144. Anal canal Anal canal is the terminal part of the gastro-intestinal tract . This is the continuation of the rectum by the ano -rectal junction. This is the passage of feces during the defecation. Anal canal is 3.8 cms of length and runs from the ano -rectal junction to anal canal in outwards

145. Relation Anterior 1 . Perineal body 2. Urethra and root of the penis in males 3. Lower end of the vagina in females

146. Posterior 1 . Ano-coccygeal ligament 2. Tip of the coccyx Side : Ischioanal fossa .

147. Interior of the anal canal The anal canal is divided into 3 zones namely, 1 . Upper mucosal part 2. Middle pectineal part 3. Lower cutaneous part.

148. Sphincters of the anal canal There are two sphincters namely, 1 . Internal anal sphincter 2. External anal sphincter.

149. Internal anal sphincter This is involuntary and formed by the circular muscles of large colon. This is situated superior to white line of the Hilton. External anal sphincter This is voluntary formed by striated muscle and covers upto opening of anal canal, has super ficial , deep & cutaneous parts.

150. Ano -rectal ring A muscular ring present in the ano -rectal region. This is formed by the pubo-rectalis , internal anal sphincter, external anal sphincter.

151. Arterial supply 1 . Superior rectal artery 2. Inferior rectal artery. Venous supply 1 . Internal rectal venous plexus 2. External rectal venous plexus Lymphatic drainage : Internal iliac node. Nerve supply 1. Sympathetic from the L1 and L2. 2. Parasympathetic S2, S3 and S4.

152. Applied aspects Hemorrhoids: Internal piles is the true piles is due to dilatation of the internal rectal venous plexus. Fissure in ano : This is due to rupture of the anal valves due to severe constipation. Fistula in ano : Extra opening around the area of anus which connects the anal canal internally.

153. Biliary apparatus

154. Biliary apparatus is formed by the group of ducts and gall bladder. Right and left hepatic duct Both right and left hepatic ducts are formed in the region of the porta - hepatis .

155. Common hepatic duct The right and left hepatic duct united and forms the common hepatic duct. The common hepatic duct runs downwards and end by connecting with the cystic duct. The hepatic duct is formed in the porta hepatis and it is 3cm in length. Cystic duct The cystic duct is formed in the neck of the gall bladder. It is 3cm in length. This has the mucosal folds called valves of heister

156. Ga ll bladder The gall bladder is a sac like structure present in the inferior fossa (cystic fossa ) of the liver . The gall bladder is 10cm in length and 3cm in width . This is 20 to 40 ml in capacity

157. three parts 1 . Fundus 2. Body 3. Neck of the gall bladder

158. Fundus Fundus is the inferior part of the gall bladder and projects away from the inferior border of liver .

159. Body The fundus is continued upwards as body . This is present in the fossa in the inferior surface of liver The body is widest part and hold the bile

160. Neck The neck is a narrow part and continuation of the body. The neck of the gall bladder present in the superior part of the porta hepatis The posterior part has a pouch called hartmann's pouch.

161. Common hepatic duct The common hepatic duct from liver and the cystic duct from the gall bladder are united and forms bile duct. It is 7 to 11 cm in length and has 6mm in diameter. This runs downwards and forms hepato -pancreatic duct. This hepato -pancreatic duct gets opened into ampulla of vater .

162. Sphincter of the bile duct The various sphincters are present in the biliary apparatus . The terminal part of the bile duct has a sphincter choledochus . The hepato - pancreatic duct has sphincter of the oddi

163. Arterial supply 1. Cystic artery 2. Superior pancreatico -duodenal artery 3. Right hepatic artery

164. Venous drainage 1 . Hepatic vein, cystic vein and portal vein Lymphatic drainage Cystic node, hepatic node and upper pancreatico - splenic node. Nerve supply Sympathetic from the T7 to T9 and right phrenic nerve and parasympathetic from the vagus nerve.

165. Applied aspects Inflammation of the gall bladder is called cholcystitis cause pain in right hypochondriac Stone formation in gall bladder is called cholelithiasis .

166. liver

167. This is a largest gland in our body performs many metabolic function in human body. Liver is the accessory organ of digestion and it is helpful for metabolism.

168. Site and situation The liver covers the right hypochondrium , it covers the epigastrium , right lumbar and also extends to left hypochondrium .

169. Size and shape The liver is a wedge shaped organ and it has approximately 1300 to 1500 grams.

170. External features Liver has five surfaces and one border Surfaces are, Anterior surface Posterior surface Superior surface Inferior surface Right surface Border : This has only one prominent border as inferior border and has small apex facing towards left and base in the right surface

171. Anterior surface This is related with the anterior part of dome of diaphragm, costal cartilages and lower ribs, costal margins, intercostal muscles and anterior abdominal wall.

172. Posterior surface This is a small surfaces related with dome of diaphragm

173. Right surface This is related with the dome of diaphragm, lower six ribs and costo -diaphragmatic recess of the pleura.

174. Superior surface This is entirely related with the diaphragm and closely attached. In the superior surfaces, the area which not covered by the peritoneum is called bare area of the liver .

175. Inferior surface This is the surface which related with the visceral organs. There is a small depression seen in which the gall bladder is present. Hence, called cystic fossa and the linear opening is called porta hepatis .

176. Structure passing through the porta hepatis 1 . Portal vein 2. Hepatic artery 3. Right and left hepatic duct.

177. Lobes of liver The liver has two lobes, 1. Larger right lobe 2. Smaller left lobe. The right and left lobes are divided by 1 . Falciform ligament, 2. ligamentum teres 3. ligamentum venosum

178. The right lobe is further divided into the, 1 . Quadrate lobe 2. Caudate lobe. Caudate lobe : seen in the upper part Quadrate lobe : seen in lower part . The porta hepatis seen between these two lobe.

179. Relation of liver 1 . Anterior : diaphragm, ribs, intercostal muscles and anterior abdominal wall. 2. Posterior : dome of diaphragm, crus of diaphragm, inferior vena cava, sympathetic chain and azygos vein. 3. Inferior : visceral organs and right side has the hepatic flexure of large intestine 4.Superior : Diaphragm and bare area. 5.Right side : Costal margin, costo-diaphargmatic recess of pleura. 6.Left side : Stomach, pancreas and spleen

180. impression 1. Gastric impression : stomach 2. Hepatic flexure: transverse colon 3. Renal impression : right kidney and right supra renal gland 4. Oesophageal impression : oesophagus 5. Vena cava impression : inferior vena cava 6. Duodenal impression : duodenum.

181. Blood supply Portal vein: 80% of blood is supplied by the portal vein. The portal vein has bring metabolites from intestine to liver 20% supplied by the hepatic artery Venous drainage : hepatic vein Nerve supply Sympathetic by the T10 to T12 from the coeliac plexus and parasympathetic by the vagus nerve. Both the sympathetic and parasympathetic forms the hepatic plexus and supply the liver.

182. Inflammation of liver is called hepatitis. This may due to infection or amebic . Viral hepatitis is common among the men and a fatal disease. Chronic alcoholism or fatty liver, leads to fibrosis and shrinkage of liver known as cirrhosis of liver also called end stage of liver disease.

183. pancreas

184. Pancreas is the accessory organ of digestion . The pancreas is a dual functional organ which has both endocrine and exocrine function . The endocrine function which synthesis the hormones namely, somatostain , insulin and glucogon . The exocrine part secretes pancreatic juice

185. Site and situation Pancreas located in the posterior abdominal wall and present horizontally This occupies umbilical and left hypochondrium

186. Size and shape This is "J" shaped structure, has 15- 20cm in length and weight upto 90gms and 2 cms in thickness.

187. External features 1 . Head and uncinate process 2. Neck 3. Body 4. Tail

188. Head Head is a broadest part & is convex nature. The head is located over the concavity of the C shaped duodenum. one process known as uncinate process .

189. Neck This is slightly a narrow part present between the head and trunk of the pancreas

190. Body This is a long part directed upwards towards left present between the neck and tail . . A small projection seen in initial part of the body is called tuber omentale .

191. Tail This is the left part related with hilum of spleen and suspended by the lieno -renal ligament.

192. Duct of the pancreas Secretion of pancreas are passing through major, minor and accessory pancreatic duct . The major pancreatic duct begins from tail of pancreas and passes through body, neck and head. Then drains into duodenum through major duodenal papillae.

193. Arterial supply 1 . Pancreatic branch of the splenic artery. 2. Superior pancreatico - duodenal artery 3. Inferior pancreatico - duodenal artery

194. Venous drainage : Superior mesenteric vein and portal vein. Lymphatic drainage 1 . Pancreatico - splenic node and coeliac node and superior mesenteric node. Nerve supply Parasympathetic by the vagus and sympathetic by the pancreatic plexus

195. Function 1 . Helps in the digestion of the protein, fats and carbohydrates 2. Helps in the endocrine function by the secretion of hormones

196. Applied aspects Deficiency of pancreatic enzymes causes disturbance in digestion . Deficiency of insulin causes diabetes mellitus.

197. Umbilicus Umblicus is a prominent depression present in anterior abdominal wall . This is the remaining part of the umbilical cord. Seen at the level of L3 and L4 . But, this is lower in children and obese person. Importance The venous blood and lymph above to umbilicus do not cross in the umbilical region. This is called water shed.

198. Inguinal Ligament The lower border of an oblique muscles forms the aponeurosis and folded backwards is called inguinal ligament. This extends from the anterior superior iliac spine to pubic tubercle . This separates the pelvic cavity and lower limb

199. Inguinal Canal This is a muscular canal formed in the lower part of anterior abdominal wall which present above to the inguinal ligament and having 4 cms in length and runs downwards and medially. The inguinal ligament begins from the deep inguinal ring and extends upto the superficial inguinal ring.

200. hernia Internal hernia : the content is protrude in peritoneal cavity through the epiploic foramen. External hernia : There are several external hernia namely, inguinal, umbilical, femoral, epigastric , lumbar, incisional hernia. Umbilical hernia: This is congenital or acquired seen in children; the mid gut is failed to entry into abdominal cavity. Femoral hernia : This is seen in females and content protrude through femoral canal Inguinal hernia : protrusion of abdominal content through inguinal canal.