B.
Gastrointestinal Tract
− 5 meters in live subjects
− 9 meters in cadavers
− Divided into Upper and Lower GI Tract
o Demarcated by the Ligament of Trietz
at the terminal portion of the
duodenum
Upper GI Tract:
1. Esophagus
2. Stomach
3. Duodenum
Lower GI Tract:
1. Jejunum
2. Ileum
3. Cecum
4. Colon
5. Sigmoid
6. Rectum
Greater Omentum
- Curtain-like structure hanging in front of the
abdominal viscera
- Attached to the greater curvature of the
stomach
- Double layered visceral peritoneum; folds
back to attach to the transverse colon
Divisions of the Greater Omentum:
1. Gastrocolic ligament – greater curvature to
the transverse colon
2. Gastrosplenic ligament – greater curvature to
the spleen
Lesser Omentum
- Connects the lesser curvature of the stomach
and the proximal part of the duodenum to the
inferior surface of the liver
- Hepatogastric ligament – lesser curvature to
the inferior surface of liver
- Hepatoduodenal ligament – proximal portion
of duodenum to inferior surface of liver
Esophagus
- Muscular tube extending from the pharynx to
the stomach
- Posterior to trachea, pierces the diaphragm at
the level of T10 (Eat-10)
- Lower esophageal sphincter – constriction of
the esophagus prior to its connection to the
stomach, protects and guards the segment
from the harmful acids of the stomach,
prevents reflux of food to the esophagus
- Z line – inner wall of the esophagus, zigzag
line appearance at the wall of the distal
esophagus, transition of epithelial lining from
stratified squamous nonkeratinized to simple
columnar
The Stomach Exterior
Stomach
- At the upper left quadrant of the abdomen
- Covered by the left lobe of the liver
Cardia
- Initial dilated portion of the stomach that
connects the stomach to the esophagus
Fundus
- Adjacent to cardia, beneath the diaphragm
Body
- Central dilated portion of the stomach
- Bordered by the greater and lesser curvatures
on the sides
Greater curvature
- Convex side of the body
- Attachment of the greater omentum
Lesser curvature
- J-shaped concave side of the body
- Incisura angulare – sharp angulation of the
curvature, attachment of the lesser omentum
Pylorus
- Tapering region of the body before connecting
to the duodenum
- Divided into two:
o Antrum – connects the body of the
stomach to the pylorus
o Pyloric canal – connects pylorus to
the first part of duodenum
Blood Vessels of the Stomach
1. Left Gastric Artery
o From Celiac Trunk
o Supplies the Upper half off the lesser
curvature
o Anastomoses with the right gastric
artery
2. Right Gastric Artery
a. From Common Hepatic Artery
b. Inferior half of the lesser curvature
3. Left Gastroepiploic Artery
a. From Splenic Artery (branch of celiac
trunk)
b. Upper half of greater curvature
c. Anastomoses w/ right gastroepiploic
artery
4. Right Gastroepiploic Artery
a. From Gastroduodenal Artery
b. Lower half of greater curvature
5. Short Gastric Arteries
a. From Splenic Artery
b. Fundus
6. Left and Right Gastric Veins
a. To the Portal Vein
b. Drains the lesser curvature
7. Left and Right Gastroepiploic Artery
a. Drains the greater curvature
b. Left: to Splenic vein
 c. Right: to Superior Mesenteric Vein
Celiac Trunk branches:
- Left gastric artery
- Common hepatic artery
o Hepatic artery proper – supplies the
liver via L+R hepatic arteries and the
gallbladder via the Cystic artery
o Gastroduodenal artery – supplies the
duodenum (Ant Sup + Pos Sup
pancreaticoduodenal arteries),
greater curvature (R gastroepiploic
artery)
o *Superior pancreaticoduodenal
arteries anastomose w/ the inferior
pancreaticoduodenal arteries (from
Superior Mesenteric Artery)
o Right Gastric artery
- Splenic artery
o Passes horizontally behind the
stomach to reach the splenic hilum
o Gives off the short gastric arteries
STOMACH INTERIOR
Gastric Rugae
- Folds of the stomach wall
Pyloric sphincter
- Strong ring of smooth muscle guarding the
terminal portion of the pyloric canal
- Regulates release of gastric content to the
duodenum
Duodenum
Pancreatic head
- At the concave side of the duodenum
Plicae circulares / Valves of Kerckring
- Numerous folds of the lumen of duodenum
Major duodenal papilla
- Ampulla of Vater
- Small, rounded elevation on the medial side of
the lumen of the duodenum
- Opening for the bile duct and pancreatic duct
on the medial wall of the descending part of
duodenum
Duct of Santorini
- Accessory pancreatic duct
- Bypasses the ampulla of Vater
- Nonfunctional
Blood supply of the duodenum:
- Superior pancreaticoduodenal arteries – from
gastroduodenal artery
- Inferior pancreaticoduodenal arteries – from
superior mesenteric artery
First part: Superior
- Continuation of pylorus
- INTRAPERITONEAL
Second part: Descending
- Ampulla of Vater
- Duct of Santorini
Third part: Horizontal
- Crossed by the Superior mesenteric artery and
vein
Fourth part: Ascending
- Held by the Ligament of Treitz
o Attaches duodenum to diaphragm
*All other parts of duodenum are RETROPERITONEAL
SUPERIOR MESENTERIC ARTERY
- From the anterior surface of abdominal aorta
Branches of SMA:
1. Inferior pancreaticoduodenal arteries
a. Anterior and posterior
b. Supplies the Inferior half of pancreas
and distal duodenum
2. Jejunal and ileal arteries
a. Supplies the jejunum and ileum,
respectively
b. Anastomose to form the arcade
arteries
c. Vasa Recta – from the arcade arteries,
supplies the wall of small intestine
3. Ileocolic artery
a. Supplies the cecum, appendix, and
proximal segment of the ascending
colon
4. Right colic artery
a. Terminal branch of SMA
b. Supplies the distal end of the
ascending colon and the hepatic
flexure
5. Middle colic artery
a. Supplies the proximal 2/3 of the
transverse colon
SUPERIOR MESENTERIC VEIN
Branches:
1. Right gastroepiploic vein – distal half of lesser
curvature
2. Inf pancreaticoduodenal vein – lower half of
duodenum and pancreas
3. Jejunal and ileal veins – jejunum and ileum
4. Ileocolic vein – cecum and appendix
5. Right colic vein – ascending colon
6. Middle colic vein – transverse colon
JEJUNUM AND ILEUM
Jejunum – middle portion of the small intestine,
begins after the ligament of Trietz
Ileum – last segment of the small intestine
*no clinical landmark between jejunum and ileum
Cecum
- First segment of the large intestine
- At the right iliac fossa
- Blood vessels: ileocolic artery and vein
Appendix - Lies on the upper and lower quadrants of the
- Vermiform appendix abdomen
- At the McBurney’s point Sigmoid colon
o Line between ASIS and umbilicus, 1/3 - Last segment of the colon
distance from ASIS - Terminates at the rectosigmoid junction
Taenia Coli - Supplied by the sigmoid arteries, on of the
- Three band smooth muscle at the anterior terminal branches of the inferior mesenteric
surface of the cecum, ascending, transverse, artery
descending, and sigmoid colon VASCULATURE OF THE COLON
- Haustration of the large intestine SMA: supplies the cecum, appendix, ascending and
Mesoappendix proximal 2/3 of transverse colon
- Portion of mesentery connecting the ileum to - Ileocolic
the appendix - Right colic
- Encloses appendicular vessels and lymphatics - Middle colic – watershed area demarcates
Appendicular artery midgut and hindgut
- Terminal branch of the ileocolic artery Terminal branches of Inferior mesenteric artery(IMA) -
- Branch of SMA supplies the rest of the colon
Appendicular vein - Left colic
- Accompanies the appendicular artery - Sigmoid
- Tributary of the ileocolic vein, drains to the Marginal artery
SMV - Anastomoses of the arteries of the colon,
Ileocecal valve and sphincter gives rise to several vasa recta
- Bauhin’s valve Vasa Recta
- Controls the flow of contents from the ileum - Supplies directly to the walls of the colon
to the cecum Superior Rectal Artery
- Terminal continuation of the IMA
COLON - Supplies the superior region of the rectum
Haustra - Anastomoses with other arteries of the
- Sacculations of the large intestine, gives the rectum:
colon its segmental appearance caused by the o Midde rectal – from internal iliac
Taenia Coli artery
Epiploic appendages o Inferior rectal – from internal
- Small pouches of peritoneum forming fatty pudendal artery
tags attached on the surface of the colon Inferior Mesenteric Vein
- A.k.a. ornamental appendages - Left colic – drains distal third of transverse
Ascending colon colon, splenic flexure, and descending colon
- Retroperitoneal - Sigmoid – drains the sigmoid colon
- Supplied by the ileocolic and right colic artery - Superior rectal – drains the superior rectum
- Drained by corresponding veins
Hepatic flexure
- Right colic flexure
- Sharp bend from ascending to transverse
colon under the liver
Splenic flexure
- Left colic flexure
- Transverse to descending colon
- Below the spleen
Transverse colon
- Hangs off the stomach via the greater
omentum
- Attached to the posterior abdominal wall via
the transverse mesocolon
- Blood supply: middle colic (proximal), left colic
(distal)
Descending colon
- Supplied by the left colic artery and vein