Tractus Digestivus

MUH. IQBAL BASRI

Anatomy Department
Hasanuddin University
 Composition
Digestive tubes
• Mouth
• Pharynx
• Esophagus
• Stomach Duodenum
Jejunum
• Small intestine
Ileum
• Large intestine

Digestive glands
• Major salivary glands
• Liver
• Pancreas
 Mouth
Pharynx

Esophagus
Major salivary glands

Stomach
Liver

Pancreas
Duodenum

Large intestine

Jejunum
Ileum
The Oral Cavity
Consists of two parts
◼ Vestibulum oris: between cheeks and
lip and teeth
◼ Cavum oris proprii: within arch of
teeth
Boundaries
◼ Anterior and lateral: gum and teeth
◼ Posterior: isthmus of fauces

◼ Roof: palate

◼ Floor: tongue, muscles and mucous

membrane
Oral vestibule leads, by the space behind
the molar teeth, into the oral cavity
proper
Palate
Two parts
◼ Hard palate: anterior 2/3,
formed by the maxilla and
palatine bone
◼ Soft palate: posterior 1/3
❑ Velum palatinum
❑ Uvula
❑ Palatoglossal arch
❑ Palatopharyngeal arch
Isthmus of fauces
formed by posterior border of
velum palatinum, both side of
palatoglossal arches, and root
of tongue.
Teeth

General features
◼ Two sets:
❑ Deciduous
❑ Permanent
◼ Classification:
❑ Incisors
❑ Canine
❑ Premolars
❑ Molars
Deciduous teeth: are 20 in number
◼ Ten teeth in each mandibular and maxillary arch
◼ Central incisor, lateral incisor, canine, first molar and second
molar in each quadrant

Upper jaw Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ total 20

Lower jaw in. in. can. mol. mol.

◼ Eruption: stars at about 6 mouth of age and continues to

beginning of 3rd year
◼ Shedding: occurs between 6th and 12th years with replacement
by permanent teeth
Permanent teeth (adult): are 32 in number
◼ Sixteen in each mandibular and maxillary arch

◼ Two incisors, one canine, two premolars, and three

molars in each quadrant
Upper jaw 1 2 3 4 5 6 7 8 total 32

Lower jaw
◼ First permanent molar－ appears at about 6 years
◼ Third molars (wisdom teeth)－many erupt at any time
after 12 years of age or not at all (impaction).
Tongue －muscular organ
Two parts: divided two parts by v-
shaped terminal sulcus
◼ Body of tongue －ant 2/3，
apex of tongue －free rounded tip
◼ Root of tongue － post 1/3

At the apex of terminal sulcus is a

small median pit, the foramen
caecum of tongue
Lingual mucous membrane
◼ Papillae of tongue
❑ Filiform papillae
❑ fungiform papillae
❑ foliate papillae contain taste buds
❑ vallate papillae
◼ Lingual tonsil
◼ －masses of submucosal
lymphoid tissue on the root of tongue
Inferior surface of
tongue

◼ Frenulum of tongue
－a midline fold of mucous
membrane connecting tongue
to floor of mouth
◼ Sublingual caruncle
－small elevation
◼ Sublingual fold
Muscles of tongue
◼ Intrinsic muscles of tongue
❑ Involved in changing shape of
tongue
❑ Include longitudinal, transverse
and vertical muscles of tongue
◼ Extrinsic muscles of tongue
❑ Genioglossus
◼ Arises from mental spine of
mandible and inserts into either
side of midline of tongue
◼ Action: acting together draw tongue
forward and downward (depresses
and protrudes tongue ); acting
along making apex of tongue to
opposite side
❑ Hyoglossus
❑ Tyloglossus
❑ Involved in determining shape and
position of tongue
Major salivary glands
Parotid gland
◼ Superficial part: triangular in
shape, lies below and in front of
the external acoustic meatus, and
partially covers the masseter.
◼ Deep part: lies deep to medial
pterygoid .
◼ Parotid duct: arises front anterior
border of gland, runs over the
masseter a finger’s breadth below
the zygomatic arch to pierce the
buccinator and opens into the
mouth cavity, opposite the upper
second molar tooth
Submandibular gland
◼ Position: lies in submandibular
triangle, between anterior and
posterior bellies of digastric
◼ Duct opens on to sublingual
caruncle
Sublingual gland
◼ position: situated beneath the
mucous membrane of the floor of
mouth
◼ Ducts
❑ Major sublingual duct－opens
onto the sublingual caruncle
❑ Minor sublingual ducts－open
onto the sublingual fold
The Pharynx

General features
◼ A –fibromuscular tube,
part of digestive and
respiratory systens
◼ Extends from base of skull
to the inferior border of
cricoid cartilage (lower
border of C6 leavel)
◼ Three segments
Nasopharynx －posterior to
nasal cavities
◼ Extends from the base of skull
to level of soft palate, below
◼ Features
❑ Pharyngeal opening of
auditory tube Tubal torus
❑ Pharyngeal recess
❑ Tubal tonsil
❑ Pharyngeal tonsil
Oropharynx －posterior to
oral cavity
◼ Lies below soft palate, extends
to upper border of epiglottis
Oropharynx
◼ Features
❑ Median glossoepiglottic fold
❑ Epiglottic vallecula
❑ Palatine tonsil －lies within
tonsillar fossa
Lymphatic ring－consists of
pharyngeal tonsil, tubal tonsil,
and lingual tonsil, forming a
circular band of lumphoid
tissue at oropharyngeal
isthmus
Laryngopharynx －posterior to larynx
◼ Extends from upper border of epiglottis to the level of lower
border of C6
◼ Pyriform recess－a deep depression on each side of aperture
of larynx, common side for lodgement of foreign bodies (for
example, fish bones)
The Esophagus
General features －a
muscular tuber about 25cm
long, connecting the
pharynx at level of C6
vertebra, passes through
the diaphragm at level of
T10 vertebra and after 1~2
cm enters the stomach
Division:
◼ Cervical part

◼ Thoracic part

◼ Abdominal part
Three constrictions
◼ At its beginning, 15cm
from incisors, lies at level of
C6, is the narrowest part of
the esophagus
◼ Where it is crossed by left
main bronchus, 25cm from
incisors, lies at level of
intervertebral disc between
T4 and T5.
◼ Where it passes through
the esophageal hiatus of
diaphragm, 40cm from
incisors, at level of T10
The Stomach
Shape

◼ Two surface: anterior and posterior

◼ Two curvatures
❑ Lesser curvature : short, concave and
directed to the right and upward, near its
lower part is angular incisure
❑ Greater curvature : long, convex and
directed to the left and downward, at the
junction of left margin of esophagus and
greater curvature is cardiac incisure
◼ Two openings
❑ Cardia
❑ Pylorus
Four parts
◼ Cardiac part
◼ Fundus of stomach
◼ Body of stomach
◼ Pyloric part
❑ Pyloric antrum
❑ Pyloric canal
 Fundus of stomach

Cardiac part

Body of stomach

Pyloric canal Pyloric antrum

Pyloric part
Structure of stomach wall
－consists of four usual layers
◼ Mucous membrane
◼ Submucous ( loose areolar tissue
connecting the mucous and
muscular layer)
◼ Muscular layer contains:
❑ The most superficial longitudinal
frbres
❑ Inner circular fibres
◼ Sphincter of pylorus
◼ Pyloric valve
❑ Innermost oblique fibres
◼ Serous (visceral peritoneum)
Position
－Mainly parts is situated in the left hypochondriac region, small
in the epigastric region; the cardia is situated to the left of T11,
the pylorus lies to the right of L1
The Small Intestine
◼ About 5-7m long,
◼ Divided into
❑ Duodenum
❑ Jejunum Duodenum

❑ Ilium

Jejunum
Ilium
Duodenum
Four parts
◼ Superior part
❑ Duodenal cap
❑ Superior duodednal
flexure
◼ Descending part
❑ Longitudinal fold of
duodenum
❑ Major duodenal papilla
❑ Minor duodenal papilla
❑ Inferior duodenal flexure
◼ Horizontal part
◼ Ascending part
❑ duodenojejunal flexure
◼ Suspensory muscle of duodenum (ligament of Treitz), a
surgical landmark, descends from the right crus of diaphragm
to duodenal termination.
Jejunum and ileum
Characteristic Jejunum Ileum
Position Upper 2/5 Lower 3/5
Diameter Greater Less
Wall Thicker Thin
Circular folds Larger, numerous and Fewer，smaller and
large villi less abundant villi
Vascularity Greater Less
Vasa recta Long Short
Colour Deeper red Paler pink
Lymphatic follicles Solitary Aggregated
Fat in mesentery Less More
Jejenum and ileum
Meckel’s diverticulum
◼ Persistence of proximal portion of yolk sac(vitelline
duct, omphalomesenteric duct)
◼ Common malformation of digestive tract (2－4%) －
more prevalent in males
◼ About 2－5cm long and located 30－100cm from
ileocecal valve
◼ Usually asymptomatic but:
❑ May become inflamed (mimicking appendcitis) or bleed
❑ May be attached to umbilicus by a fibrous cord (distal end
of yolk stalk) and cause intestinal obstruction by
compressing adjacent intestinal loops
Large Intestine

◼ Approximately 1.5m long,

◼ Five parts:
❑ Caecum
❑ Vermiform appendix
❑ Colon
❑ Rectum
❑ Canal
Large Intestine
Features
◼ Colic bands
◼ Haustra of colon
◼ Epiploic appendices
Caecum
◼ Blind sac, first part of large
intestine, with largest
diameter and thinnest wall
◼ Lies in right iliac fossa
◼ The ilium enters the cecum
obliquely, and partially
invaginates into it, forming
the ileocaecal valve－
consists of two folds,
probably delays flow of ileal
contents into large intestine
Vermiform appendix
◼ Blind worm-like tube, 6－
8cm long, about 0.5cm in
diameter
◼ Opens into posteromedial
aspect of cecum，about 2
cm below ileoceal orifice
◼ The base at the appendix
lies at the point of
convergence of three colic
bands (used as a guide
to find the appendix during
operation)
◼ Surface marking of the
base is at the so-called
McBurney’s point which
is at junction of lateral
and middle thirds of line
joining right anterior
superior iliac spine and
umbilicus
Tip variable in position
◼ Preileal －28%
◼ Pelvic－26%
◼ Retrocecal －24%
◼ Retroileal－8%
◼ Subcecal－6%
Mesentery of vermiform appendix
◼ Triangular mesentery－extends
from terminal part of ileum to
appendix
◼ Appendicular a. runs in free
margin of the mesoappendix then
along wall of appendix
Colon
◼ Ascending colon
❑ right colic flexure
◼ Transverse colon
❑ left colic flexure
◼ Descending colon
descends almost vertically
from left colic flexure to
sigmoid colon at left iliac
crest.
◼ Sigmoid colon－extends
from descending colon to
rectum at level of S3.
Rectum
Position: within pelvic cavity,
extends from S3 to pelvic
diaphragm.
Curves
◼ Sagittal plane
❑ Sacral flexure
convex backward
❑ Perineal flexure
convex forward.
◼ Coronal plane
❑ Upper and lower part－convex
to the right.
❑ Middle part－convex to the left.
Lower part of rectum dilated, to
from ampulla of rectum
◼ Three transverse folds of
rectum
Anal canal
◼ Anal columns －6-11 in number,
◼ Anal valves
◼ Anal sinuses
◼ Anorectal line
◼ Dentate line
❑ Above line, of endodermal origin
❑ Below line, of ectodermal origin
◼ Anal pecten
◼ White line (Hilton’s line)
◼ Anus
◼ Anal sphincters
❑ Sphincter ani internus
❑ Sphincter ani externus
The Liver

Shape
◼ Two surfaces
❑ Diaphragmatic surface
◼ Convex and smooth
◼ Divided into right and left
lobes by falciform lig. of
liver
❑ Visceral surface
Visceral surface －
has a H-shaped fissures
and grooves
◼ Left limb of H

❑ Anteriorly: fissure for

ligamentum teres hepatis
❑ Posteriorly: fissure for
ligamentum venosum
◼ Right limb of H
❑ Anteriorly: fossa for
gallbladder
❑ Posteriorly: sulcus for
vena cava
◼ Cross-bar of H is the porta
hepatic: traversed by right
and left hepatic ducts, left
and right branches of
proper hepatic artery and
hepatic portal vein, nerves
and lymphatic vessels.
These structures which are
surrounded by connective
tissue called hepatic
pedicle
◼ Four lobes: left, right,
quadrate and caudate lobes
Inferior border –thin and
sharp
◼ Notch for ligamentum
teres hepatis
◼ Nothch for gallbladder
Position: Most of liver lies in the right
hypochondriac region and epigastric
region, less part extending into the left
hypochondriac region
Surface projection
◼ Upper border: on the right
midclavicular line it extends the level
of 5th rib
◼ Lower border: Normally, the right lobe
extends just beneath the costal margin,
it doesn’t down beyond the costal
margin; on the anterior median line its
lower border crosses a point about
3~5cm below the xiphoid process. In
children, the liver being larger in
proportion to the body than in the adult
stage, it extends below the costal arch
within in 2cm.
The segments of the liver
◼ The segmentation of the liver, bases upon the principal
divisions of the proper hepatic artery and accompanying
hepatic ducts and hepatic portal vein－Glisson system.
◼ The hepatic veins, however do not follow the same pattern
and vary: their main tributaries tend to run rather
intersegmental.
Extrahepatic Biliary Apparatus

Consists of
◼ Gallbladder

◼ Left and right hepatic

ducts
◼ Common hepatic duct

◼ Common bile
Gallbladder
Position :lies in fossa for gallbladder
on visceral surface of liver
Four parts
◼ Fundus of gallbladder

Surface projection: at the junction

of right midclavicular line and right
costal arch
◼ Body of gallbladder

◼ Neck of gallbladder

◼ Cystic duct

Function: stores and concentrate

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

Supraduodenal segment
◼ Descends along the right
margin of hepatoduodenal lig.
◼ To the right of proper hepatic a.

◼ Anterior to hepatic portal v.

Retroduodenal segment
◼ Behind the superior part of
duodenum
◼ Anterior to the vena cava

◼ To the right of the hepatic

portal v.
Pancreatic segment
◼ Lies in a groove between
posterior surface of head of
pancreas and duodenum
Intraduodenal segment
◼ Enters the wall of
descending part of
duodenum obliquely where
jions the pancreatic duct to
form the hepatopancreatic
ampulla
◼ opens at the major
duodenal papilla
Bile is secreted by the liver cells Biliary ductuli Right and left hepatic ducts

Common hepatic duct Cystic duct Gallbladder (store, concentrate)

when the fat enters the small intestine,

the gallbladder contracts, the sphincter
of hepatopancreatic ampulla relax

Common bile duct

Major duodenal papilla

Triangle of Calot
◼ Boundaries: the common hepatic duct on the left, the cystic
duct on the right, the liver, superiorily
◼ Content: cystic artery
The Pancreas
Shape and Position
◼ A soft yellowish
lobulated gland
◼ Lies behind the
peritoneum on the
posterior abdominal
wall, roughly at the
level of of L1~L2
Three parts
◼ Head
❑ Flattened and located in
C-shaped curvatune of
duodenum
❑ Uncinate process
◼ Neck－constricted part
◼ Body
◼ Tail－runs in base of
lienorenal ligament to
reach hilum of spleen
Pancreatic duct
◼ Main Pancreatic duct
❑ Begins at tail and
throughout gland
❑ Joins common bile duct
before entering
descending part of
duodenum at major
duodenal papilla
◼ Accessory pancreatic
duct
❑ Opens 2cm above main
duct at lesser duodenal
papilla
Divisions and relations of pancreas

Head of pancreas
◼ Located in C-shapes curvature
of doudenum
◼ Anteriorly
❑ Transverse mesocolon
◼ Posteriorly
❑ Inferior vena cava
❑ Right renal vessels
❑ Common bile duct
Neck of pancreas
◼ Anteriorly－pylorus
◼ Posteriorly－commencement pf
hepatic portal v. (formed by union of
splenic and superior mesenteric
veins
Body of pancreas
◼ Anteriorly
❑ Separated from stomach by
omental bursa
◼ Posteriorly
❑ Abdominal aorta
❑ Left suprarenal gland
❑ Left kidney
❑ Left renal vessels
❑ Spleen vein
◼ Superiorly
❑ Celiac trunk
❑ Celiac plexus
❑ Splenic a.
Tail of pancreeas
❑ Runs in spleicorenal
ligament to reach hilum
of spleen
❑ Accompanies with
splenic vessels
Relationships of the organs

Muh. Iqbal Basri

Department of Anatomy
Hasanuddin University
Relationships of abdominal viscera

◼ First layer－live, gallbladder, stomach

◼ Second layer－duodenum, pancreas, spleen
◼ Third layer－suprarenal gland, kidney, ureter,
inferior vena cava, abdominal aorta, nerves
and lymphatics
Relationships of the stomach
◼ Anterior:
❑ Liver (right part)
❑ Diaphragm (left upper part)
❑ Anterior abdominal wall (left
lower part)
◼ Posterior－separated by
peritonum of lesser sac from
the following (“stomach-bed”)
❑ Pancreas
❑ Left suprarenal gland
❑ Left kidney
❑ Spleen
❑ Transverse colon and
transvers mesoclon
The duodenum

Relationships of superior part

◼ Anteriorly
❑ Quadrate lobe of live
❑ Gallbladder
◼ Posteriorly
❑ Commom bile duct
❑ Gastroduodenal a.
❑ Hepatic portal v.
❑ Inferior vena cava
◼ Superioely
❑ Omental foramen
◼ Inferiorly
❑ Head of pancreas
Relationships of
descending part
◼ Anteriorly
❑ Live
❑ Transverse colon and
mesocolon
❑ Loops of small intestine
◼ Posteriorly
❑ Right renal hilum and ureter
❑ Right renal vessels
◼ Medially
❑ Head of pancreas
❑ Common bile duct and
pancreatic duct
◼ Laterally
❑ Right colic flexure
Relationships of horizontal
part
◼ Superiorly

◼ Head of pancreas

◼ Inferiorly

❑ Loops of small intestine

◼ Anteriorly
❑ Radix of mesentery
❑ Superior mesenteric a. and
v.
◼ Posteriorly
❑ Right ureter
❑ Inferior vena cava
❑ Abdominal aorta
Relationships of ascending part
◼ Right
❑ Head of pancreas and abdominal aorta
◼ Left
❑ Left kidney and ureter
Relationships of liver
◼ Diaphragmatic surface－
separated by diaphragm from
the following
❑ Right costodiaphramatic
recess and lung
❑ Cardiac base
◼ Visceral surface
❑ Left lobe is related to the
stomach and abdominal part
of esophagus
❑ Right lobe is related to the
right colic flexure anteroly,
gallbladder and superior
duodenal flexure medially,
right kidney, superarenal gland
posteriorly
Divisions and relations of common bile duct

Supraduodenal segment
◼ Descends along the right
margin of hepatoduodenal lig.
◼ To the right of proper hepatic a.

◼ Anterior to hepatic portal v.

Retroduodenal segment
◼ Behind the superior part of
duodenum
◼ Anterior to the vena cava

◼ To the right of the hepatic

portal v.
Pancreatic segment
◼ Lies in a groove between
posterior surface of head of
pancreas and duodenum
Intraduodenal segment
◼ Enters the wall of
descending part of
duodenum obliquely where
jions the pancreatic duct to
form the hepatopancreatic
ampulla
◼ opens at the major
duodenal papilla
Divisions and relations of pancreas

Head of pancreas
◼ Located in C-shapes curvature
of doudenum
◼ Anteriorly
❑ Transverse mesocolon
◼ Posteriorly
❑ Inferior vena cava
❑ Right renal vessels
❑ Common bile duct
Neck of pancreas
◼ Anteriorly－pylorus
◼ Posteriorly－commencement pf
hepatic portal v. (formed by union of
splenic and superior mesenteric
veins
Body of pancreas
◼ Anteriorly
❑ Separated from stomach by
omental bursa
◼ Posteriorly
❑ Abdominal aorta
❑ Left suprarenal gland
❑ Left kidney
❑ Left renal vessels
❑ Spleen vein
◼ Superiorly
❑ Celiac trunk
❑ Celiac plexus
❑ Splenic a.
Tail of pancreeas
❑ Runs in spleicorenal
ligament to reach hilum
of spleen
❑ Accompanies with
splenic vessels
Relationships of spleen

Diaphragmatic surface
－diaphragm
Visceral surface
◼ Anteriorly－fundus of
stomach
◼ Posteriorly－left
suprarenal gland and
kidney
◼ Inferiorly－tail of
pancreas and left colic
flexure