Clinical

Anatomy of
GIT and
Urinary Tract
astari anggara
 Embriology
• Foregut : Pharynx primordial
(cavum oris, lingua, glandula
salivarius), respiratory system,
esofagus sampai papilla duodeni
mayor, hepar, pankreas
• Midgut: Duodenum sisanya
sampai 2/3 proksimal colon
transversum
• Hindgut: sisanya ditambah
epitel vesica urinaria dan uretra
Cont’ed
• Cavitas peritonii: Coeloem intraembryonic
• Peritoneum parietal: mesoderm somatic
• Peritoneum visceral: mesoderm splachnic
• Mesenterium: double layer peritoneum
• Mesogastrium dorsal omentum majus, lig. Gastrolienalis, lig.
Gastrophrenica, lig. Gastrocolica
• Mesogastrium ventral lig. Falciformis, lig hepatoduodenal, lig
hepatogastrica
Esophagus
• VC6-VT11
• Pars cervical, thoracal, abdominal
• Inner circular, outer longitudinal
• Penyempitan (angustia) superior, media, inferior
• GERD, kelemahan
Klinis sphincter lower. Yg mana
sphincter lower?
• Fistula tracheoesophageal • Achalasia
• Varises esofageal
(portocaval shunt)
 Vaskularisasi
• a. gastrica dexter & sinister anastomosis di
Gaster curvatura minor
• a. gastroepiploica dex & sin anastom di
• Fundus, cardia, corpus, pars curvatura mayor
pylorus, pylorus • a. gastrica brevis & posterior suplai fundus
• v. gastrica dex et sin v. Porta hepatica
• Incissura cardiaca & incissura
• v. gastroepiploica sin & brevis v. Lienalis
angularis • v. gastroepiploica dex v. Mesenterica sup
• Tunica mucosa: rugae gastrica,
canalis gastricus
• Tunica muscularis: outer
longitudinal, middle circular,
inner oblique
• Tunica serosa: peritoneum
visceral
• Hal 132
Inervasi
Parasimpatis: trunkus vagus ant & post
Simpatis: T6-T9 n. splachnicus mayor
 Sliding hernia

Con’t ed
Paraesophageal hernia

Klinisnyaa..
• Hiatal hernia
• Hernia diafragma congenital (bochdalek)
• Hypertrophic pyloric stenosis
• Ca gaster, sering di pylorus
• Gastroscope (nasally/orally)
• Gastrectomy (total dan parsial)
• Gastritis dan gastric ulcer
• Vagotomy
truncal: jarang!
selective: Cuma dipilih yg menuju ke segmen
gaster tertentu
 Ini dia hernia bochdalek
• Ada kelemahan diafragma posterolateral sinistra, jadi ususnya
protrusi ke thorax
• Disertai agenesis pulmo sinistra
Duodenum
• Pars superior (ada ampullanya lho), pars descenden, pars horizontal, pars
ascenden
• Yang mana yg intraperitoneal dan retro?
– Intra : duo superior ascenden
– Retro : duo descenden dan longitudinal
• Lig. hepatoduodenal deket pilorus 134
• Flexura duodeni superior (L1) et inferior (L3) hal 139
• Flexura duodenojejunales (L2) ligamentum suspensorium
duodenojejunales (Treitz)
• Papilla duodeni mayor dan acessorius
• Plica circularis
Vaskularisasi
• 139
A. Gastroduodenal
• No 3 duct A. Pancreaticoduodenal sup
coledocus inf
Venanya ke v. Porta hepatis
Inervasi
n. Vagus dan n. Splachnicus
mayor et minor
Lanjoot..
Klinisnya apaan dong?
• Duodenal ulcer: bisa erosi ke a. gastroduodenal
• Peptic ulcer: karna asam lambung berlebih
• Hernia paraduodenal: di sekitar flexura duodenojejunales
melalui fossa duodeni sup et inf, fossa paraduodenal, plica
paraduodenal
Jejunum & ileum
• Bedanya apa hayo?
• Junctio duodenojuejunales-
junctio ileocaecal
• Radix mesenterii (L2 sinistra-art.
Sacroiliaca dex)
• Isi mesenterium: vasa
mesenterica sup, limfonodi
(juxta-mesenterica, mesenterica,
centralis superior), nervus
• Vaskularisasi: a. Jejunales dan a.
Ileales (masih inget cabang dari
apa?)
Cont’ed
Nah klinisnya..
• Diverticulum ilei (Meckel):
gagalnya penutupan duct
omphalomecentericus
– 74% free 26% nempel ke
umbilicus
– Mucosa: ileal type, gastric
type, pancreatic, jejunale,
atw colonic
• Iskemia small intestine: occlusi vasa
recta oleh emboli nekrosis ileus
• Ileus: nyeri colic, distensi, vomiting, fever
dan dehidrasi
• Ileostomy: stoma dari ileum ke kulit
dinding anterolateral
•Megacolon (Hirschprung)
Large Intestine
• Caecum, appendix, colon
ascenden, transversum,
descenden, sigmoid, rectum,
dan canalis analis
• Haustra & incissura semilunaris
• Appendices epiploica
• Taenia coli (libera, mesocolica,
omentalis)
• Plica semilunaris
• Mesocolon transversum
• Mesocolon sigmoid
• Flexura hepatica & lienalis
• Junctio rectosigmoid
• Posisi appendix? Retrocaecal,
preileal, retroileal, pelvica, dll
167
• Hal 140 163
Klinisnyaa
• Appendicitis, McBurney di
garis Monroe
• Colectomy (removal)
• Colitis
• Colostomy, pembuatan stoma
di pars terminal colon
• IBD
• Diverticulosis, diverticulitis
• Volvulus, hanya untuk yg intra
Rectum & Anus
• Retroperitoneal dan
subperitoneal
• Canalis analis
• Linea pectinata (dentata), batas
embriologis
• Junctio anocutan
• M. Levator ani
• M. Sphincter ani internus
(involunter)
• M. Sphincter ani externus
(volunter)
• 205
Klinisss
• Atresia ani
• Stenosis ani
• Hemorrhoid
– Internal: plexus venosus
rectalis internal
– Eksterna: plexus venosus
rectalis externa, sakit
Batesnya si linea dentata
Hepar
• Intraperitoneal
• Fascies diaphragmatica &
visceralis
• Recessus subphrenicus &
hepatorenal
• Area nuda, sulcus vena cava
inferior
• Fossa vesica fellea, porta
hepatis (apa aja? )
• Impressio
• Lobus anatomis, fisiologis
• Segmen? 142-144
Blood flow
Truncus coeliacus - a. Hepatica communis – a.
Hepatica propria – porta hepatis - ramus dex et sin
v. Mes sup + v. Lienalis = v. Porta hepatica
v. Mes inf ke v. lienalis
Vena2 abdomen – v. Porta hepatica – sinusoid – v.
Centralis – v. Hepatica – VCI
Portocaval shunt
Letak Porta Cava
Esofagus v. gastrica sinistra v. esofageales
Paraumbilical v. paraumbilicalis v. Epigastrica superficialis
Anus v. Rectalis sup v. Rectalis med&inf
Retroperitoneal v. Colica sinistra v. Lumbalis ascenden

Klinisnya..
• sirosis hepatis
• hepatomegaly
• hepatitis
Organ aksesoris lainnya
• Lien: splenomegaly (inget
schuffnernya), splenectomy
• Vesica fellea: cholecystitis,
cholelithiasis (termasuk
choledocolithiasis,
cholecystolithiasis) bikin nyeri
colic biliarry

Referred Painnya kemana?

Gaster : T6-T9 ke epigastric
Cholelithiasis, hepar, ductus
cysticus: T6, bisa sampe scapula
dorsal dexter
Summary Inervasi dan Vaskularisas
Foregut
• badan sel preganglionik di nucleus intermediolateralis (IML) T6-9
• serabut preganglionik : T6-9 (N. Splachnici mayor)
• badan sel postganglionik : Ganglion coeliacum

Midgut
• bdn sel preganglionik : IML T10-12
• serabut preganglionik : T10-12 (n. Splachnici minor)
•Bdn sel postganglionik : Ganglion mesentericus superior

Hindgut
• IML L1-3
• L1-3 (N. Splachinici lumbales)
• G. Mesentericus sup
URINARY & ABDOMINAL WALL
Lanjut dikit lagii, smangat! 
Abdominal Wall
• 9 Regio
• M. Obliqus externus (V)
• M. Obliqus internus (A)
• M. Transversus
Subcostal (costa 10)

2 versi garis transversa:

• transpyloric & interspinosa
• subcostal & transtubercular
Clinical oriented?
• Incisi abdomen
• Peritonitis
• Adhesi peritoneum: perlekatan
viscera, bsa jadi volvulus
• Adhesiotomy
• Ascites: excavatio douglas (cewe),
excavatio rectovesica, recessus
hepatorenal (supine)
• Abdominal paracentesis : untuk
ambil cairan, adm antibiotik.
Melalui dinding abdomen
anterolateral (linea alba)
• Intraperitoneal dialysis: seperti
menyaring cairan (darah).
Peritoneum sebagai membran
semipermeabel. Digunakan
temporer
• Injeksi intraperitoneal
 Hernia Abdominales
Locus minoris resistante
• Fossa inguinalis media (trigonum
Hasselbach)
• Fossa inguinalis lateral
• Trigonum lumbales
• Annulus femoralis
• Annulus umbilicales
Maka jenis hernianya..
• Hernia direct
• Hernia indirect
• Hernia lumbales
• Hernia femorales
• Hernia umbilicalis
• Hernia epigastrica
Urinary System
Embriologi
• Pronephros
• Mesonephros: glomeruli dan tubulus mesonephros, ductus
mesonephricus
• Metanephros: primordia ren permanen
Ren permanen berkembang dari 2 sumber:
• Diverticulum metanephric (ureteric bud): ureter, pelvis renalis, sistema
collectivus
• Metanephrogenic blastema: parenkim (nephron)
Ren migrasi week 9
Kelainan congenital
• Bifid renal pelvis and ureter:
complete – incomplete
• Horseshoe kidney : tertahan di
bawah a. Mesenterica inf (L3-
L5)
• Ectopic pelvic kidney: ren di
pelvis
• Retrocaval ureter
• Polycystic kidney: autosomal
dominan
Anatomy normalnya?
• T12-L3
• Retroperitoneal
• Lemak pararenal, fascia
renalis (Gerotta), lemak
perirenal, capsula renalis
(capsula fibrosa)
• Fiksasi ren : fascia2 dan
lemaknya, tekanan
intraabdm, vasa renalis dan
ureter
• Collecting system : Papilla
renalis, calix minor, calix
mayor, pelvis renalis, ureter
Cont’ed
• Ureter (pars abdominalis & pars pelvica)
• Vesica urinari: ingat detrusor + reflex miksi?
Langsung klinisnya aja ya..
• Nephroptosis: turun lebih dari 3cm
• Glomerulonephritis, Pyelonephritis
• Hydronephrosis + Hydroureter,
obstrusi
• Ureterolithiasis, predileksi ada 3
• Vesicolithiasis
• Suprapubic cystostomy
• Cystoscopy (transurethra)
• Incontinensia
– True: fistula, extrofi bladder
– Stress: kelemahan
diafragma pelvis
– Urge: hiperrefleks m.
Detrusor, spastic UMN,
flaccid LMN
– Overflow: udh penuh ga
bisa kontraksi, atw ga bisa
keluar mis. BPH
• ESWL
• Cystoscopy
• Bladder extrofi
ALHAMDULILLAH 