HNSS ANATOMY

Endocrine and Alimentary Layers of the Neck

 Learning Objectives

1. To enable the students to understand the general

functions of the endocrine system
2. To enable the students to describe the functions of
each of the endocrine glands and the respective
hormones they secrete
3. To enable the students to explain how hormones
interact to produce coordinated physiological
responses
4. To enable the students to identify the different layers
of the cervical esophagus
ENDOCRINE SYSTEM
 Endocrine System Overview
• Ductless glands produce
hormones
• Secreted directly into the
bloodstream
• Gland may be entire organ:
– Pituitary, thyroid,
parathyroid, pineal,
adrenal
• Or bits of tissue interspersed
within an organ
– Gonads, kidneys, many
others
 ENDOCRINE SYSTEM
FUNCTIONS:
A. Water balance
B. Uterine contraction and milk release
C. Growth, metabolism and tissue maturation
D. Ion regulation
E. Heart rate and blood pressure regulation
F. Blood glucose control
G. Reproductive function control
 PITUITARY GLAND
Also called hypophysis cerebri; Ovoid in
shape and connected by the infundibulum to
the tuber cinerium of the brain
The tuber cinereum is a hollow eminence of gray
matter situated between the mammillary bodies and
the optic chiasma. The tuber cinereum is part of the
hypothalamus.
 PITUITARY GLAND
LOCATION:
Hypophyseal fossa which is the deepest part
of the sella turcica of the sphenoid bone
 PITUITARY GLAND
RELATIONS:

SUPERIORLY – Diaphragm sella

INFERIORLY – Sphenoid
LATERALLY – Cavernous sinus
POSTERIORLY - Dorsum sella, vertebral
arteries and pons
 PITUITARY GLAND
NAME THE TWO PARTS:
A. Adenohypophysis – Anterior lobe
B. Neurohypophysis – Posterior lobe
 Adenohypophysis
Adenohypophysis includes the pars anterior (pars
distalis or glandularis), pars intermedia and pars
tuberalis.
The adenohypophysis is highly vascular.
The main mass of the adenohypophysis may be
divided into the pars anterior (pars distalis) and
the pars intermedia, which are separated in fetal
and early postnatal life by the hypophysial cleft, a
vestige of Rathke's pouch.
 Neurohypophysis
The neurohypophysis is a diencephalic downgrowth
connected with the hypothalamus. The
adenohypophysis is an ectodermal derivative of
the stomatodeum.
Neurohypophysis includes the pars posterior (pars
nervosa, posterior or neural lobe), infundibular
stem and median eminence.
 PITUITARY GLAND
Average dimensions of the pituitary are 10
mm A-P; 15 mm side to side and 5 mm
superior to inferior; Average weight is 0.5 gm;
Female pituitary gland is approximately
larger than the male by approximately 20%.
During pregnancy, female pituitary gland
increases in size approximately 10% because
of the hypertrophy of prolactin secreting cells
 PITUITARY GLAND
BLOOD SUPPLY AND VENOUS DRAINAGE:

Superior and inferior hypophyseal arteries

from the ICA.

Intercavernous sinus
 PITUITARY GLAND
ADENOHYPOPHYSIS Adrenocorticotropic hormone
Thyroid-stimulating hormone
Growth hormone
Leutenizing hormone
Follicle stimulating hormone
Interstitial Cell-Stimulating
Hormone (ICSH)
Melanocyte–stimulating hormones
Prolactin
NEUROHYPOPHYSIS Oxytocin and
Antidiuretic hormone
 HYPOTHALAMUS
It synthesizes and secretes certain
neurohormones, often called hypothalamic-
releasing hormones, and these in turn stimulate or
inhibit the secretion of pituitary hormones. The
hypothalamus controls body temperature, hunger,
thirst, fatigue, sleep, and circadian cycles.

Regulatory hormone production (RH and IH)

controls pituitary gland directly and all other
endocrine glands indirectly
HYPOTHALAMUS
 PINEAL GLAND
Also called the pineal body, epiphysis cerebri,
epiphysis or the "third eye") is a small
endocrine gland in the vertebrate brain. It
produces the serotonin derivative melatonin,
a hormone that affects the modulation of
wake/sleep patterns and seasonal functions.
Its shape resembles a tiny pine cone and it is
located near the center of the brain, between
the two hemispheres, tucked in a groove
where the two rounded thalamic bodies join.
 PINEAL GLAND
LOCATION:
Lies between the superior colliculi. It is attached by
a stalk to the region of the posterior wall of the
third ventricle . It is located in basal forebrain near
thalamus
PINEAL GLAND
PINEAL GLAND
 PINEAL GLAND
The pineal is an endocrine gland of major
regulatory importance. It modifies the activity
of the adenohypophysis, neurohypophysis,
endocrine pancreas, parathyroids, adrenal
cortex, adrenal medulla and gonads. Its
effects are largely inhibitory.
 PINEAL GLAND
• Primary timing center for circadian rhythms
– Reset by daily light/dark changes
• Melatonin is involved in aligning physiology with
sleep/wake cycle & seasons
– Secreted at night & is inhibited by light
– The abundant melatonin levels in children are
believed to inhibit sexual development, and pineal
tumors have been linked with precocious puberty.
– When puberty
. arrives, melatonin production is
reduced. Calcification of the pineal gland is typical
in adults
11-67
 PINEAL GLAND
BLOOD SUPPLY AND DRAINAGE:

Posterior choroidal artery with venous

drainage into great cerebral veins
 THYROID GLAND
LOCATION:
Located in the middle of the lower neck,
below the larynx and just above the clavicle
and anterior to the trachea
 THYROID GLAND
GROSS FEATURES:
Consist of right and left lobes connected by
the isthmus. Vascular organ surrounded by
pretracheal layer of the deep cervical fascia.
Lobe is pea-shaped. The isthmus extends
from 2nd – 4th tracheal rings. A pyramidal
lobe is often present and it projects upward
from the isthmus with glandulae thyroidea, a
band connecting the pyramidal lobe to the
hyoid bone
 THYROID GLAND
NORMAL WEIGHT: 15 to 20 grams
HORMONES SECRETED: These hormones regulate
the rate of metabolism and affect the growth and
brain development and rate of function of many
other systems in the body.
Thyroxine
Triiodothyronine
Calcitonin – Decreases blood calcium
concentration
 THYROID GLAND
Superior thyroid artery – Descend to the upper poles of
each lobe accompanied by the external laryngeal
nerve; Originates from the ECA

Inferior thyroid artery – Ascends behind the gland to the

level of the cricoid cartilage. Accompanied by the
recurrent laryngeal nerve; Originates from the
thyrocervical trunk (subclavian artery)

Thyroidea ima artery – Ascends in front of the trachea to

the isthmus; brachiocephalic trunk, arch of aorta, left
common carotid artery
 THYROID GLAND
VENOUS AND LYMPHATIC DRAINAGE:

Superior thyroid vein – IJV

Middle thyroid vein – IJV
Inferior thyroid vein - -L brachiocephalic vein

Deep cervical and paratracheal group of nodes

 PARATHYROID GLANDS
LOCATION:
Four in number and intimately related to the posterior
border of the thyroid gland, lying within its fascial
capsule. The superior parathyroid glands are more
constant in location and lie in the level of the middle
of the posterior border of the thyroid gland. Inferior
parathyroid glands lie close to the inferior pole of the
thyroid gland. They may lie within the fascial sheath,
embeded in the thyroid substance or outside the
fascial sheath. At times they are found caudal to the
thyroid gland even in the superior mediastinum.
 PARATHYROID GLANDS
GROSS FEATURES:
Yellowish brown and ovoid shape measuring
6 mm in its greatest diameter

HORMONES SECRETED:
PTH – Increases blood levels of calcium
 PARATHYROID GLANDS
BLOOD SUPPLY:
Superior and inferior thyroid arteries

VENOUS DRAINAGE:
Superior, middle and inferior thyroid veins

LYMPHATIC DRAINAGE:
Deep cervical and paratracheal group of nodes
 PANCREAS
Has both endocrine and exocrine functions.
Best known endocrine function of the
pancreas involves glucose homeostasis.
Endocrine function of the pancreas is served
by the islets of langerhans.
 PANCREAS
HORMONES STRUCTURES THAT FUNCTION OF THE HORMONES
SECRETE
INSULIN BETA CELLS; beta cells ENHANCES THE RATE OF GLUCOSE
more centrally METABOLISM; DECREASES BLOOD
GLUCOSE LEVELS; INCREASES
GLYCOGEN STORES IN TISSUES
GLUCAGON ALPHA CELLS; PROMOTES GLCOGENOLYSIS AND
concentrated at the GLUCONEOGENESIS
periphery of islets
PANCREATIC PP CELLS; Head and DECREASE PANCREATIC EXOCRINE
POLYPEPTIDE uncinate process SECRETION; ALTER BILIARY TRACT
MOTILITY
SOMATOSTATIN DELTA CELLS; peripherally INHIBITION OF GASTRIC ACID
placed within the islets; SECRETION, DECREASE GIT MOTILITY
Periphery of the gland AND DECREASE GIT BLOOD FLOW
 ADRENAL GLANDS
DESCRIBE THE LOCATION AND RELATIONS
Anatomically, the adrenal glands are located in
the retroperitoneum situated atop the kidneys,
one on each side. They are surrounded by the
perinephric fascia but separated from the kidneys
by the perinephric fat. In humans, the adrenal
glands are found at the level of the 12th thoracic
vertebra.
ADRENAL GLANDS
DIFFERENTIATE THE LEFT AN RIGHT
ADRENAL GLANDS GROSSLY
Right adrenal gland is pyramidal in shape. It lies
behind the right lobe of the liver and extends
medially behind the IVC. It rest posteriorly on the
diaphragm.

The left is crescentric in shape and extends along

the medial border of the left kidney. It lies behind
the pancreas, lesser sac, stomach and rest
posteriorly on the diaphragm.
 Embryonic Development of
Adrenal Glands
Fetal adrenal glands are disproportionately
enlarged and exhibit extraordinary growth in a
specialized cortical compartment known as the
fetal zone. This fetal zone atrophies soon after
birth.
 Hormones Secreted by Adrenal
Cortex and Medulla
HORMONES ORIGIN FUNCTION

ALDOSTERONE Cortex Reabsorption of Na and excretion of K

CORTISOL Cortex Promotes gluconeogenesis and accumulation of

glycogen in the liver; Antagonizes insulin

ANDROGENS Cortex Secondary male characteristics; Influence the

development of male external genitalia and male
ductal structures such as vas deferens, epididymis and
seminal vessicle
EPINEPHRINE Medulla Catecholamines are sympathomimetic. "fight-or-
flight" hormones released by the adrenal glands in
NOREPINEPHRINE Medulla response to stress. They are part of the sympathetic
nervous system.
 ADRENAL GLANDS
BLOOD SUPPLY:
• The superior suprarenal artery is provided by the
inferior phrenic artery
• The middle suprarenal artery is provided by the
abdominal aorta
• The inferior suprarenal artery is provided by the
renal artery
 ADRENAL GLANDS
VENOUS AND LYMPHATIC DRAINAGE:
• The right suprarenal vein drains into the inferior
vena cava
• The left suprarenal vein drains into the left renal
vein or the left inferior phrenic vein.

LYMPHATIC DRAINAGE:
Lateral aortic nodes
 TESTIS AND OVARY
LOCATION:
Testis is a mobile organ within the scrotum

Ovary is an almond shape organ which lies

against the lateral wall of the pelvis on a
depression called ovarian fossa.
 TESTIS AND OVARY
NAME THE STIMULATING HORMONES
 TESTIS AND OVARY
NAME THE TARGET CELLS OF THE STIMULATING
HORMONE:
 TESTIS OVARY
STIMULATING FSH and LH FSH and LH
HORMONES
TARGET CELLS LH stimulates the Leydig FSH stimulates the
cells to produce maturation of the
OF THE testosterone; FSH binds to graafian follicle and its
STIMULATING Sertoli cells to enhance production of
HORMONES spermatogenesis estradiol. LH causes
folicular
rupture...ovulation
and maintenance of
the corpus luteum
Give the Function of the Hormones
Secreted
Estrogen – Stimulation for the development of the
secondary female characteristics to include the female
external genitalia, deposition of fats, enlargement of the
breast, development of the uterus and fallopian tube
Progesterone – Regulates the menstrual cycle by promoting
the secretory changes in the endometrium by preparing
the uterus for implantation of the fertilized ovum
Testosterone - Enables the growth of male sex organs and
maintain male body habitus like the penis and scrotum
growth, stimulates growth of hair
 TESTIS AND OVARY
BLOOD SUPPLY: TESTIS
1. Testicular artery from the aorta
2. Collateral blood supply from the cremasteric
artery (a branch of the inferior epigastric artery,
which is a branch of the external iliac artery), and
the artery to the ductus deferens (a branch of the
inferior vesical artery, which is a branch of the
internal iliac artery
BLOOD SUPPLY: OVARY Ovarian artery from aorta
 TESTIS AND OVARY
LYMPHATIC DRAINAGE: Paraaortic nodes

VENOUS DRAINAGE:
TESTIS: Right spermatic vein > IVC
Left spermatic vein > Left renal vein

OVARY: Ovarian vein > right on the IVC

left renal vein
ORGAN HORMONE FUNCTION

Stomach Gastrin Plays an important role in

control of gastric acid
secretion.
Small Cholecystokinin Cholecystokinin: A small
Intestine and Secretin intestinal hormone that
stimulates secretion of
pancreatic enzymes and
bile.

Secretin: stimulates
secretion of a bicarbonate-
rich fluids from the
pancreas and liver.
ORGAN HORMONE FUNCTION
Liver Insulin-like Growth Insulin-like Growth Factor-1 -
Factor-1 immediate stimulus for growth
of the body; Angiotensinogen
Angiotensinogen
serves as the precursor for
Thrombopoietin angiotensin; the role it plays in
Hepcidin maintaining blood pressure;
Thrombopoietin stimulates
precursor cells in the bone
marrow to differentiate into
megakaryocytes; Hepcidin It
blocks the release of iron from
intracellular stores in the body;
also serves as a defense against
invasion by pathogenic bacteria
ORGAN HORMONE FUNCTION

Kidney Erythropoietin and Erythropoietin increases the

Calcitriol production of red blood cells;
Calcitriol stimulates the cells
of the intestine to promote
the absorption of calcium
from food and bone to
mobilize calcium from the
bone to the blood
Placenta Human chorionic HCG maintains the corpus
gonadotropin luteum of pregnancy
Placental Lactogen Placental lactogen prepares
Progesterone the mammary glands for
lactation
ALIMENTARY LAYERS OF THE NECK

1. Pharynx
2. Esophagus
 General Structure of Digestive Tract

• Common Characteristics:
• Hollow tube composed of a lumen whose diameter varies.
• Surrounded by a wall made up of 4 principal layers:
1. Mucosa
• Epithelial lining; A lamina propria of loose connective tissues rich in
blood, lymph vessels and smooth muscle cells; Muscularis
mucosae.
2. Submucosa
• Dense connective tissues with many blood and lymph vessels.
3. Muscularis
• Contains smooth muscle cells, divide into 2 layers; internal
(circular); external (longitudinal)
4. Serosa
• Thin layer of loose connective tissue rich in blood and lymph
vessels and adipose and single squamous covering epithelium
General Structure of Digestive Tract
 Pharynx
The oral pharynx is lined by a stratified squamous
non-keratinizing type of epithelium and lacks both
muscularis mucosae and submucosa. The epithelium
rests on a lamina propria that contains a thick layer
of longitudinally oriented elastic fibers.

The muscularis externa is composed of somewhat

irregularly arranged skeletal muscle, the longitudinal
and constrictor muscles of the pharynx. Mucous
glands are seen in the muscular layer and some are the
extensions of those present in the lamina propria.
 Pharynx
Different regions are lined by a different type of
epithelium. Regions of the pharynx that are likely to be
roughened up by food are lined by stratified squamous
epithelium. Other regions of the pharynx are lined by
ciliated pseudostratified epithelium with goblet cells.
(nasopharynx).

The vestibule is lined by stratified squamous epithelium.

Pharynx
 Esophagus
The esophagus is subdivided into:
1. Upper (entirely skeletal muscle in the muscularis
externa) - In the upper esophagus, the muscularis
externa consists of both inner and outer layers of
skeletal muscle only.
2. Middle (mixed smooth and skeletal muscle)- In the
middle esophagus, the muscularis externa contains a
mixture of skeletal and smooth muscle.
3. Lower (entirely smooth muscle) portions.

Present in all regions of the esophagus (upper, mid, and

lower) is the myenteric (Auerbach’s) plexus
 Esophagus
The esophageal epithelium is the non-keratinized
stratified squamous type and is supported by a
connective tissue lamina propria.
In additional to the characteristic submucosal glands of
the esophagus, small mucous glands may be found
scattered in the lamina propria of the upper and
lower esophagus. A thick layer of longitudinally
arranged smooth muscle fibers form the muscularis
mucosae.
 Esophagus
The connective tissue of the submucosa consists of
mostly collagenous fibers with some elastic fibers and
varying amounts of fat as well as submucosal sero-
mucous glands.
The wall of the esophagus consists of four layers:
mucosa, submucosa, muscularis propria, and adventitia.
Unlike other areas of the GI tract, the esophagus does
not have a distinct serosal covering. (anastomotic
leak)
Esophagus
 References

Wineski, Lawrence: Snell’s Clinical Anatomy by Regions, 10th

Edition, 2018.

Snell, Richard: Clinical Anatomy by Regions, 9th Edition, 2011.

Moore, K.L., Dalley, A.F., and Agur, A.R.:Clinically Oriented

Anatomy, 8th Edition, 2017

Mescher, A.L.: Junqueira's Basic Histology Text & Atlas, 14th

Edition, 2016.