Dr. Ágoston Szél

Gross Anatomy of the and Small Intestines

Institute of Anatomy, Histology and Embryology Semmelweis University 2020. Topography of visceral organs

Lungs Heart

Stomach Liver Gall bladder Caecum Gross anatomy of stomach Cardial notch Cardial part „J” Fundus Body Cardia Lesser curvature

Lesser omentum Angular notch Duodenum

Pylorus (gatekeeper) Pyloric Greater curvature part Greater omentum Pyloric canal Pyloric antrum anterior – posterior wall Stomach (gr. Gaster - sac) Section of stomach

Cardial notch Gastric Cardial orifice fundus

Gastric canal

Pyloric sphincter

Pyloric orifice

Pyloric canal

Pyloric antrum Longitudinal (gastric) folds curved tube Angle of His betwen cardia und fundus (normally: an acute angle of opening)

Relations of stomach

Diaphragm A: hepatic surface

A

B

C Spleen

Liver

Costal arch B: phrenic surface

C: free surface „Gastrostomy” (stomach field) Radiology of stomach Esophagus Fundus (containing air) Lesser curvature 5th intercostal space

Fluid level Angular notch

Corpus Bulbus duodeni

Pylorus Greater curvature

Pyloric antrum Radiology of Diaphragm stomach

Fundus Esophagus

Angular Cardial notch notch

Corpus Bulbus duodeni Greater Pyloric curvature orifice

Pyloric canal Pyloric antrum Radiology of stomach

Superior Pyloric orifice part Lesser curvature Superior flexure of duodenum Angular Bulb of notch duodenum Pyloric antrum

Descending Pyloric part of canal duodenum Greater curvature Peristaltic contraction Radiology of stomach Fundus Lesser curvature

Angular notch Corpus

Greater curvature Folds of mucous Pyloric membrane canal Pyloric Inferior antrum pole Variations in the shape of stomach

Steerhorn-shaped stomach (hypertonic Hook-shaped stomach) stomach

Gastroptosis Long stomach Peptic ulcer (sinking of (hypotonic (hour-glass stomach) stomach) shape) Ulcer of stomach (hour-glass) Prepare your smart phone! QR-code will appear for registering your attendance ATTEND-AOKANT674_1A - 2020-02-12 15_10_00 Celiac trunk and blood supply of stomach

Splenic artery Left gastric artery Short gastric arteries Celiac trunk Inferior phrenic artery Right gastric artery Cystic artery Splenic Proper hepatic artery branches Gastroduodenal artery

Superior Left gastroepiploic artery pancreatico- duodenal artery Common hepatic artery Right gastroepiploic artery Abdominal aorta Venous drainage of stomach

Splenic vein Short gastric Left gastric vein vein

Right gastric vein

Portal vein

Prepyloric vein Left gastroepiploic vein Inferior mesenteric Pancreatico- vein duodenal vein Right gastroepiploic vein Superior mesenteric vein Lymph nodes of stomach

Left gastric lymph Pancreatico- nodes lienal lymph nodes

Pyloric lymph nodes

Right gastric and subpyloric lymph nodes Lymphatic drainage of stomach

Gastric lymph nodes

Celiac lymph nodes

Intestinal trunk Left supraclavicular lymph nodes Cisterna chyli

Enlarged lymph Thoracic duct nodes in the left supraclavicular fossa (Virchow) Left venous angle Innervation of stomach

Left vagus nerve Right vagus nerve (anterior trunk) (posterior trunk)

Sympathetic trunk Sympathetic trunk Thoracic splanchnic Esophageal plexus nerve Celiac lymph nodes

Left gastric Greater splanchnic nerve lymph nodes Lesser splanchnic nerve Anterior gastric Hepatic branch of vagus branches Celiaci plexus and ganglia Posterior gastric branches Innervation of the stomach

Vagus nerve : musculature and glands of the stomach

Sympathetic trunk : sphincter muscles

Greater splanchnic nerve – spinal nerves: sensory fibers Left anterior vagal trunk Branches to Total vagotomy corpus and fundus Left vagal branches to stomach Proximal Gastric selective vagotomy vagotomy

Left vagal branches to Pyloric small branches intstines

Vagus nerve Esophageal opening of diaphragm

Suprahiatal Endothoracic phrenico-esophageal fascia ligament Diaphragm

Transversalis fascia Subhiatal phrenico- esophageal ligament

Peritoneum Esophago-gastric junction Cardial orifice (Z-line level with Th11) Sliding (par glissement Paraesophageal hiatus hiatus hernia) hernia Projection of internal organs

Lungs

Heart

Stomach Liver

Duodenum Gall bladder Ascending colon Descending colon Position of Coils of Free Small Intestines

Duodenum: horseshoe-shaped Jejunum: more vertical

Ileum: more horizontal Longitudinal Section of Human Duodenum

Circular folds (folds of Kerkring)

Topography of the Duodenum

Hepatoduodenal lig. Pylorus Esophageal opening

Superior part L I. Suspensory lig. of duodenum Superior duodenal flexure

Descending part Jejunum

Aortic hiatus L III. Inferior duodenal flexure Ascending part

Horizontal part Blood Supply of Duodenum

Splenic artery Left gastric artery Common hepatic artery Coeliac trunk

Proper hepatic artery

Gastroduodenal artery

Superior pancratico- duodenal artery Left gastroepiploic artery Bühler’s anastomosis

Superior mesenteric Inferior pancratico- artery duodenal artery Duct Openings into the Duodenum

Right hepatic duct Left hepatic duct Common hepatic duct Cystic duct

Lesser pancreatic duct Gall bladder Common duct Lesser duodenal papilla Greater pancreatic duct

Greater duodenal papilla

Branches of Superior Mesenteric Artery

Superior mesenteric artery Inferior pancratico-duodenal artery

Middle colic Anastomosis with inferior artery mesenteric artery Jejunal arteries Right colic artery Ileocolic artery

Posterior caecal artery Anterior caecal artery Ileal arteries Appendicular artery Topography of Duodenum

Omental tuber Esophagus Inferior phrenic artery Left gastric artery Coeliac ganglion Inferior phrenic artery Portal vein Ganglion coeliacum Suprarenal gland Suprarenal gland Proper hepatic artery Common bile duct Left colic flexure Superior pancreatico- duodenal artery Coeliac trnk Right colic flexure Abd. aorta

Head of pancreas

Superior mesenteric vein Uncinate process Right colic artery Quadratus lumborum Inferior pancreatico- Psoas major duodenal artery Iliacus muscle Superior mesenteric artery Sympathetic trunk Ureter Duodenal Duodenojejunal flexure Probe bulb

Descending part

Colic flexure Jejunum

Ascending colon

Terminal Radiographic Image of the Cecum Intestines

Ileum Diaphragm

Fundus Radiology of Duodenum

Pyloric antrum Corpus Duodenal bulb Greater Pyloric curvature orifice Ascending part Pyloric Jejunum canal Horizontal part Bibliography

• Lippert H: Lehrbuch Anatomie, Urban & Fischer, München, 2000 • Mac Kinnon P, Morris J: Oxford Lehrbuch der klinischen Anatomie, Hans Huber, Bern, 1997 • Snell RS, Clinical Anatomy, Little, Brown & Co, Boston, 1995 • Moore KL, Dalley AF: Clinically Oriented Anatomy, Lippincott, 1999