醫(yī)學(xué)資料4-3-消化管2(咽-肛管-雙語版)

1、 Mouth Pharynx Esophagus StomachDuodenumJejunumIleumLarge intestine Liver PancreasMajor salivary glands Alimentary System Anus2021/7/16 星期五1Pharynx General featuresA fibromuscular tube, part of digestive and respiratory systemsExtends from base of skull to the inferior border of cricoid cartilage (l

2、ower border of C6 level)Three segmentsNasopharynx Oropharynx Laryngopharynx 2021/7/16 星期五2 Pharynx Nasopharynx Position Posterior to nasal cavitiesExtends from the base of skull to the level of free border of palatine velumFeaturesPharyngeal opening of auditory tube Tubal torus Pharyngeal recess Tub

3、al tonsilPharyngeal tonsil 2021/7/16 星期五3 Pharynx Oropharynx Position Posterior to oral cavityExtends from free border of palatine velum to the level of upper border of epiglottisFeaturesMedian glossoepiglottic fold Epiglottic vallecula Palatine tonsil Lies within tonsillar fossa2021/7/16 星期五4Tonsil

4、litis Tonsil inflammation2021/7/16 星期五5 Pharynx Laryngopharynx Position Posterior to larynxExtends from upper border of epiglottis to the level of lower border of C6Piriform recess A deep depression on each side of aperture of larynxcommon side for lodgement of foreign bodies (for example, fish bone

5、s)2021/7/16 星期五6 Pharynx Lymphatic ring of pharynx Forming a circular band of lymphoid tissue at oropharyngeal isthmuConsists of Pharyngeal tonsiltubal tonsilPalatine tonsillingual tonsil2021/7/16 星期五7Esophagus General features A muscular tuber about 25cm longConnecting the pharynx at level of infer

6、ior border of vertebra C6Passes through the diaphragm at level of vertebra T10Ends at the cardia of the stomach, opposite vertebra T11Division Cervical part: 5cmThoracic part: 18-22cmAbdominal part: 1-2cm2021/7/16 星期五8 Esophagus Three constrictions 1. Where it beginning, 15cm from incisors, lies at

7、level of inferior border of C6, is the narrowest part of the esophagus 2. Where it is crossed by left principal bronchus, 25cm from incisors, lies at level of intervertebral disc between T4 and T5. 3. Where it pierces the esophageal hiatus of diaphragm, 40cm from incisors, at level of T102021/7/16 星

8、期五9 Stomach ShapeTwo surface: anterior and posteriorTwo curvaturesLesser curvature of stomach short, concave and directed to the right and upwardnear its lower part is angular incisure Greater curvature of stomach long, convex and directed to the left and downwardat the junction of left margin of es

9、ophagus and greater curvature is cardiac incisure Two openingsCardia Pylorus Two incisure2021/7/16 星期五10 Stomach Four partsCardiac part Fundus of stomach（ cardiac incisure ） Body of stomach （angular incisure） Pyloric part Pyloric antrum Pyloric canal 2021/7/16 星期五11Stomach Cardiac part Fundus of sto

10、mach Body of stomach Pyloric antrum Pyloric canal Pyloric part 2021/7/16 星期五12Location Mainly parts is situated in the left hypochondriac regionSmall in the epigastric regionThe cardia is situated to the left of T11, the pylorus lies to the right of L1.Stomach 2021/7/16 星期五13Structure of stomach wal

11、l consists of four usual layersMucous membraneSubmucous ( loose areolar tissue connecting the mucous and muscular layer)Muscular layer contains:Innermost oblique fibresInner circular fibresSphincter of pylorusPyloric valve The most superficial longitudinal fibers Serous (visceral peritoneum) Stomach

12、 2021/7/16 星期五14Variations in position of stomach2021/7/16 星期五15Duodenum first and widest part of small intestineextends from pylorus to duodenojejunal flexureapproximately 25cm long and 4-5 cm in diameterC-shaped and moulded around head of pancreasretroperitoneal, except for a small segment (1-3 cm

13、) at the beginningcommon bile duct and pancreatic ductsopen into the second partGeneral features2021/7/16 星期五16 DuodenumFour parts 1. Superior part Duodenal bulb Superior duodenal flexure2. Descending partInferior duodenal flexure 3. Horizontal part4. Ascending partDuodenojejunal flexure2021/7/16 星期

14、五17Descending partLongitudinal fold of duodenum Major duodenal papilla common opening of the common bile duct and pancreatic duct75cm from incisorsMinor duodenal papilla Duodenum2021/7/16 星期五18Duodenum Suspensory muscle of duodenum and Suspensory lig. of duodenum (lig. of Treitz) a surgical landmark

15、, descends from the right crus of diaphragm to duodenal termination.2021/7/16 星期五19Jejunum and ileum2021/7/16 星期五20Jejunum and Ileum CharacteristicJejunumIleumPositionUpper 2/5, upper left part of abdominal cavity Lower 3/5, lower right part of abdominal cavity DiameterGreaterLessWallThickerThinCirc

16、ular foldsLarger, numerous and large villiFewer，smaller and less abundant villiVascularityGreaterLess Color Deeper redPaler pink Lymphatic folliclesSolitaryAggregatedFat in mesentery LessMore2021/7/16 星期五21Meckels diverticulumPersistence of proximal portion of yolk sac Common malformation of digesti

17、ve tract (24%) ， more prevalent in malesAbout 25cm long and located 30100cm from ileocecal valveUsually asymptomatic but: May become inflamed (mimicking appendicitis) or bleedJejunum and Ileum 2021/7/16 星期五22 Large Intestine Approximately 1.5m long, Five parts: Cecum Vermiform appendix Colon Rectum

18、Anal canal 2021/7/16 星期五23Colic bands Haustra of colon Epiploic appendices Large Intestine Features 2021/7/16 星期五24CecumPosition lies in right iliac fossaShape: Blind sac, first part of large intestine, with largest diameter and thinnest wallThe ileum enters the cecum obliquely, and partially invagi

19、nates into it, forming the ileocecal valve Consists of two folds Probably delays flow of ileal contents into large intestine2021/7/16 星期五25 Vermiform appendix Blind worm-like tube, 5-1.0cm in diameter Opens into posteromedial aspect of cecum, about 2 cm below ileocecal orifice The base of the append

20、ix lies at the point of convergence of three colic bands (used as a guide to find the appendix during operation)2021/7/16 星期五26 Vermiform appendix Surface projection of the base at the so-called McBurneys point which is at junction of lateral and middle one-thirds of line joining right anterior supe

21、rior iliac spine and umbilicusat the so-called Lanzs point which is at junction of right and middle one-thirds of line joining right and left anterior superior iliac spines2021/7/16 星期五27 Preileal Retroileal Pelvic Retrocecal Subcecal Vermiform appendix Tip variable in positionSurface projection2021

22、/7/16 星期五28 Vermiform appendix 2021/7/16 星期五29 Colon Ascending colonRight colic flexureTransverse colonLeft colic flexureDescending colonDescends almost vertically from left colic flexure to sigmoid colon at left iliac crestSigmoid colonExtends from descending colon to rectum at level of S32021/7/16

23、 星期五30Rectum PositionWithin pelvic cavityExtends from S3 to pelvic diaphragmCurves Sagittal planeSacral flexure: convex backwardPerineal flexure: convex forward.Coronal planeUpper and lower partconvex to the rightMiddle partconvex to the leftAmpulla of rectum Lower part of rectum dilatedTransverse f

24、olds of rectum (3) 2021/7/16 星期五31Rectum 2021/7/16 星期五32 Anal canal Structures Anal columns : 6 10 in numberAnal valves Anal sinuses Anorectal line Dentate line Above line, of endodermal originBelow line, of ectodermal originAnal pecten White line (Hiltons line) Anus 2021/7/16 星期五33Anal sphinctersSphincter ani internus Sphincter ani externus Anorectal ring At junction of rectum and anal canalConsists of thickened muscleContributing structuresLevator aniSuperficial and deep parts of sphincter ani externusSphincter ani internus Anal canal 2021/7/16 星期五3420