SUMMARY OF “ANATOMY OF THE URINARY SYSTEM”

Tran Quoc Phong, MD. (*)

Overview
A muscular tube called the digestive tract (or alimentary canal) and various
accessory organs make up the digestive system. The digestive tract includes the oral
cavity (mouth), pharynx, esophagus, stomach, small intestine, and large intestine.
The accessory organs include the teeth, tongue, and various glandular organs, such
as the salivary glands, liver, gallbladder, and pancreas.
The digestive tract and accessory organs work together to perform the
following functions:
Ingestion: Ingestion occurs when foods and liquids enter the digestive tract
via the mouth.
Mechanical processing: Most ingested solids undergo mechanical processing
by the tongue and teeth before they are swallowed. Swirling, mixing, churning, and
propulsive motions of the digestive tract provide additional mechanical processing
after swallowing.
Digestion: Digestion is the chemical and enzymatic breakdown of complex
sugars, lipids, and proteins into small organic molecules that are absorbed by the
digestive epithelium.
Secretion: Digestion involves the action of acids, enzymes, and buffers
produced by active secretion. Some of these secretions are produced by the lining of
the digestive tract, but most are produced and secreted by accessory organs, such as
the pancreas.
Absorption: Absorption is the movement of organic molecules, electrolytes,
vitamins, and water across the digestive epithelium and into the interstitial fluid of
the digestive tract.
Excretion: Excretion is the elimination from the body of the undigested
residue of food and the waste products of metabolism. Waste products are secreted
into the digestive tract, primarily by the accessory glands, especially the liver.
Compaction: Compaction is the progressive dehydration of undigested
materials and organic wastes prior to excretion from the body. The compacted
material is called feces. Defecation is the elimination of feces from the body through
the anus.

(*) Giảng viên giải phẫu học - Bác sĩ ngoại tiết niệu 1
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The digestive tract
The lining of the digestive tract plays an important defensive role by
protecting surrounding tissues against (1) the corrosive effects of digestive acids and
enzymes, (2) mechanical stresses, such as abrasion, and (3) pathogens that are
swallowed with food or reside within the digestive tract.
The peritoneum
The peritoneum is a serous membrane with two parts. The visceral
peritoneum, or serosa, is continuous with the parietal peritoneum lining the inner
surfaces of the body wall. The organs of the abdominal cavity are often described as
lying within the abdominal and peritoneal cavities
Intraperitoneal organs lie within the peritoneal cavity, in that they are covered
on all sides by the visceral peritoneum. The stomach, liver and ileum are
intraperitoneal organs.
Retroperitoneal organs are covered by the parietal peritoneum on their
anterior surface only, so they lie outside the peritoneal cavity. These organs typically
do not develop from the embryonic gut. The kidneys, ureters, and abdominal aorta
are retroperitoneal.
Intraperitoneal organs: Stomach, liver, ileum, tail of pancreas, spleen,
transverse and sigmoid colon, first part of colon.
Retroperitoneal organs: kidneys, ureters, aorta, inferior vena cava, other
parts of pancreas, ascending and descending colon, middle rectum.
Subperitoneal organs: bladder, cervix of the uterus, lower rectum.
The Oral cavity
Functions of the oral cavity include (1) sensory analysis of food before
swallowing, (2) mechanical digestion through the actions of the teeth, tongue, and
palatal surfaces, (3) lubrication by mixing ingested material with mucus and saliva,
and (4) limited chemical digestion of carbohydrates by salivary amylase and lipids
by lingual lipase.
The oral mucosa lines the oral cavity. The oral mucosa is a nonkeratinized
stratified squamous epithelium that protects the mouth from abrasion.
Cheeks are the lateral walls of the oral cavity
Anteriorly, the mucosa of the cheeks is continuous with the lips
The space between the cheeks, lips, and teeth is oral vestibule.
The ridges of oral mucosa, the gingivae.

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 The tongue forms the floor of the oral cavity. The mylohyoid, which is located
inferior to the tongue, provides additional support to the floor of the oral cavity.
The hard palate separates the oral cavity from the nasal cavity, comprised of
the palatine processes of the maxilla and the horizontal plates of the palatine bones.
The soft palate lies posterior to the hard palate. It separates the oral cavity
from the nasopharynx and closes off the nasopharynx during swallowing.
The finger-shaped uvula dangles from the center of the posterior margin of
the soft palate.
The two pairs of muscular palatal arches are found on each side of the uvula.
The palatoglossal arches extend between the soft palate and the base of the tongue.
The palatopharyngeal arches extend from the soft palate to the side of the pharynx.
The tongue has four primary functions: (1) mechanical digestion by
compression and distortion, (2) manipulation to assist in chewing and to prepare
food for swallowing, (3) sensory analysis by touch, temperature, and taste receptors.
and (4) secretion of mucin and the enzyme lingual lipase.
The tongue is divided into an anterior body and a posterior root. The dorsum of the
tongue contains numerous fine projections called lingual papillae.
The tongue contains two different groups of muscles, extrinsic tongue muscles
and intrinsic tongue muscles. The hypoglossal nerve (XII) controls these muscles.
These muscles perform all gross movements of the tongue. The smaller intrinsic
muscles change the shape of the tongue and assist the extrinsic muscles during
precise movements, such as speech.
Three pairs of salivary glands secrete into the oral cavity
The parotid glands are the largest salivary glands, weighing approximately
20g. The superior, anterior portion of each parotid extends from the mastoid process
of the temporal bone anteriorly, crossing the superficial surface of the masseter. The
posterior portion of the gland extends between the inferior surface of the zygomatic
arch and the anterior margin of the sternocleidomastoid. The secretions of each gland
are drained by a parotid duct, which empties into the oral vestibule at the second
upper molar.
The mucous membrane of the floor of the mouth covers the sublingual glands.
Numerous sublingual ducts open along either side of the frenulum of the tongue.
The submandibular glands are found in the floor of the mouth along the medial
surfaces of the mandible inferior of the mylohyoid line. The submandibular ducts
open into the mouth on either side of the frenulum of the tongue, immediately

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posterior to the teeth. The autonomic nervous system controls the salivary gland
secretions. Each salivary gland receives parasympathetic and sympathetic
innervation. Parasympathetic stimulation speeds up secretion by all the salivary
glands. As a result, you produce large amounts of saliva.
Teeth perform chewing, or mastication, of food. Mastication breaks down
tough connective tissues in meat and plant fibers in vegetables
Most of each tooth consists of dentine, a mineralized matrix similar to bone.
However, unlike bone, dentine does not contain living cells. Instead, cells in the
central pulp cavity extend cytoplasmic processes into the dentine. The pulp cavity is
spongy and highly vascular. Blood vessels and nerves enter the pulp cavity by a
narrow tunnel, the root canal, located at the base, or root, of the tooth. The dental
artery, dental vein, and dental nerve enter the root canal through the apical foramen
at the tip of the root.
The root of each tooth sits in a bony cavity or socket called the tooth socket,
or tooth alveolus. Collagen fibers of the periodontal ligament extend from the
dentine of the root to the bone.
A layer of enamel covers the dentine of the crown. Enamel forms the occlusal
surface of each tooth, which is the biting surface that grinds food against the
opposing tooth surface. Enamel contains densely packed crystals of calcium
phosphate and is the hardest biologically manufactured substance.
The pharynx
A common passageway for food, liquids, and air. The pharynx contains the
nasopharynx, oropharynx, and laryngopharynx. The pharyngeal muscles cooperate
with muscles of the oral cavity and esophagus to initiate the swallowing process, or
deglutition.
The esophagus
The esophagus is a hollow muscular tube that transports foods and liquids to
the stomach
It lies posterior to the trachea slightly left of midline. It passes along the dorsal
wall of the mediastinum in the thoracic cavity and enters the peritoneal cavity
through an opening in the diaphragm, the esophageal hiatus.
The vagus and sympathetic trunks innervate the esophagus via the esophageal
plexus
Neither the upper nor the lower portion of the esophagus has a well-defined
sphincter muscle comparable to those located elsewhere along the digestive tract.

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 The terms upper esophageal sphincter and lower esophageal sphincter (or
cardiac sphincter) are used to describe these regions because they are similar in
function to other sphincters.
The stomach
The stomach is intraperitoneal and shaped like an expanded letter J. The
anterior and posterior surfaces are smooth and rounded. The stomach typically
extends between the levels of vertebrae T7 and L3. It occupies the left
hypochondriac, epigastric, and portions of the umbilical and left lumbar regions
Gastric glands contain various types of secretory cells working together to
secrete about 1500 ml of gastric juice each day.
The stomach is divided into four regions
The cardia, so named because of its proximity to the heart—is the superior,
medial portion of the stomach immediately surrounding its junction with the
esophagus. The esophageal lumen opens into the cardia at the cardiac orifice.
The fundus is the region of the stomach that projects superior to the junction
between the esophagus and the stomach. The fundus contacts the inferior and
posterior surfaces of the diaphragm.
The body of the stomach is the area between the fundus and the curve of the
J. The largest region of the stomach, the body, functions as a mixing tank for ingested
food and gastric secretions.
The pyloric part (forms the portion of the stomach between the body of the
stomach and the duodenum (first segment of the small intestine). It is divided into a
pyloric antrum, which is connected to the body, a pyloric canal, which empties into
the duodenum, and the pylorus, which is the muscular tissue surrounding the pyloric
orifice (stomach outlet).
The muscular layer of the stomach consists of a superficial longitudinal
smooth muscle layer surrounding a deeper layer of circular muscle. This pattern is
seen elsewhere along the digestive tract.
The small intestine
The small intestine has three anatomical subdivisions: the duodenum,
jejunum, and ileum.
The shortest and widest segment of the small intestine is the duodenum.
A ring of smooth muscle, the pyloric sphincter, regulates movement of chyme
from the stomach into the duodenum. From its start at the pyloric sphincter, the

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duodenum curves in a C that surrounds the pancreas. The duodenum receives chyme
from the stomach and digestive secretions from the pancreas and liver.
A sharp bend, the duodenojejunal flexure, marks the junction of the duodenum
and the jejunum. At this junction the small intestine re-enters the peritoneal cavity,
becoming intraperitoneal and supported by a sheet of mesentery. The bulk of
chemical digestion and nutrient absorption occurs in the jejunum. The jejunum is
about 2.5 m long.
The third and last segment of the small intestine is the ileum. It is
intraperitoneal and is the longest segment of the small intestine, averaging 3.5 m in
length. The ileum ends at the ileocecal valve.
The large intestine
The large intestine begins where the ileum joins with an expanded pouch
called the cecum. It ends at the anus. The large intestine absorbs water, electrolytes,
and vitamins and compacts and stores the fecal waste material.
The large intestine is often called the large bowel. It has an average length of
about 1.5 m and a width of 7.5 cm. It is divided into three parts: (1) the cecum, (2)
the colon, and (3) the rectum
The large intestine (1) absorbs water and electrolytes and compacts the
intestinal contents into feces, (2) absorbs the important vitamins produced by
bacteria, and (3) stores feces before defecation.
The cecum, which is intraperitoneal, is the first segment of the large intestine.
Materials pass through the ileocecal valve as they move from the ileum into the
cecum. The appendix is attached to the posteromedial surface of the cecum. The
appendix is normally about 9 cm (3.6 in.) long, but its size and shape are quite
variable. The primary function of the appendix is as an organ of the lymphatic
system.
The colon has a larger diameter and a thinner wall than the small intestine.
The colon is subdivided into the ascending colon, transverse colon, descending
colon, and sigmoid colon. Three separate longitudinal bands of smooth muscle
called the teniae coli run along the outer surfaces of the colon just deep to the serosa.
The serosa of the colon contains numerous teardrop-shaped sacs of fat called the
omental appendices, or fatty appendices of the colon.
The colon is subdivided into four regions: the ascending colon, transverse
colon, descending colon, and sigmoid colon. The ascending colon begins at the
superior border of the cecum. It ascends along the right lateral and posterior

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abdominal wall of the peritoneal cavity to the inferior surface of the liver. At this
point the colon turns to the left at the right colic flexure, or hepatic flexure.
The transverse colon curves anteriorly from the right colic flexure and crosses
the abdomen from right to left. As the transverse colon crosses the abdominal cavity,
its peritoneal relationship changes. Near the spleen, the colon makes a right turn,
termed the left colic flexure, or splenic flexure.
The descending colon, which is secondarily retroperitoneal, proceeds
inferiorly along the left side of the abdomen. At the iliac fossa, the descending colon
curves and becomes the sigmoid colon.
The sigmoid colon is an S-shaped segment that is only about 15 cm long. The
sigmoid colon lies posterior to the urinary bladder, suspended from the sigmoid
mesocolon. The sigmoid colon empties into the rectum.
The rectum forms the last 15 cm of the digestive tract. It is an expandable
organ for the temporary storage of feces. The last portion of the rectum is the anal
canal. It contains small longitudinal folds, the anal columns.
Accessory organs
The Liver
The liver is the largest visceral organ, a firm, reddish-brown organ weighing
about 1.5 kg
Most of its mass lies in the right hypochondriac region and epigastric regions.
The functions are:
Metabolic regulation: The liver is an essential organ for regulating body
metabolism. The liver regulates the circulating levels of carbohydrates, lipids, and
amino acids. Blood draining all of the absorptive surfaces of the stomach and small
and large intestines enters the hepatic portal system and flows into the liver. As a
result, the liver cells extract absorbed nutrients and toxins from the blood before
they reach the systemic circulation through the hepatic veins. Stores iron reserves
and store fat soluble vitamins.
Hematological regulation: The liver is the largest blood reservoir in the body,
receiving about 25 percent of the cardiac output. Liver cells synthesize and secrete
plasma proteins into the blood. Plasma proteins contribute to the osmotic
concentration of the blood, transport nutrients, and establish the clotting and
complement systems.
Production of bile: Bile is synthesized by liver cells, stored in the gallbladder,
and excreted into the lumen of the duodenum. Bile is mostly water, with small

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amounts of ions, bilirubin (a pigment derived from hemoglobin), and an assortment
of lipids known as bile salts. Bile salts make it possible for enzymes to break down
lipids in the chyme into fatty acids suitable for absorption
The liver is intraperitoneal. Deep to its visceral peritoneal layer is a tough
fibrous capsule. On the anterior surface a ventral mesentery, the falciform ligament,
marks the division between the left lobe and right lobe of the liver. The round
ligament, or ligamentum teres, is a thickening of the inferior margin of the falciform
ligament. This fibrous band marks the path of the degenerated fetal umbilical vein.
The liver is suspended from the inferior surface of the diaphragm by the
coronary ligament.
The liver has classically been described as having four lobes. The impression
left by the inferior vena cava marks the division between the right lobe and the small
caudate lobe. Inferior to the caudate lobe lies the quadrate lobe, sandwiched between
the left lobe and the gallbladder.
Two blood vessels deliver blood to the liver, the hepatic artery proper and the
hepatic portal vein. Roughly one- third of the normal hepatic blood flow arrives
through the hepatic artery; the rest arrives through the hepatic portal vein. Blood
returns to the systemic circuit through the hepatic veins, which empty into the
inferior vena cava. The arterial supply provides oxygen-rich blood to the liver, and
the hepatic portal vein supplies nutrients and other chemicals absorbed from the
intestine.
The gallbladder
The gallbladder is a hollow, pear-shaped, muscular sac. The gallbladder stores
and concentrates bile before it is released into the small intestine. The gallbladder is
located in a recess, or fossa, in the posterior surface of the liver’s right lobe.
The gallbladder is divided into three regions: the fundus, body, and neck. The
cystic duct exits the gallbladder and unites with the common hepatic duct to create
the bile duct. At the duodenum, a muscular sphincter of ampulla surrounds the lumen
of the bile duct and the duodenal ampulla. The duodenal ampulla opens into the
duodenum at the duodenal papilla, a small raised projection.
The pancreas
The pancreas lies posterior to the stomach, extending laterally from the
duodenum toward the spleen. It has three subdivisions: head, body, and tail.

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 The broad head of the pancreas lies within the loop formed by the initial
segment of the duodenum. The slender body extends transversely to the left toward
the spleen, and the tail is short and rounded.
The pancreas is a mixed gland, with both exocrine and endocrine functions.
The exocrine portion of the pancreas produces digestive enzymes and buffers. The
endocrine portion regulates blood glucose level.