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Anatomy of Major Duodenal Papilla Influences ERCP Outcomes
Journal of Clinical Medicine Article Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study Gheorghe G. Balan 1 , Mukul Arya 2, Adrian Catinean 3, Vasile Sandru 4,*, Mihaela Moscalu 1 , Gabriel Constantinescu 5, Anca Trifan 1 , Gabriela Stefanescu 1,* and Catalin Victor Sfarti 1 1 Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; [email protected] (G.G.B.); [email protected] (M.M.); [email protected] (A.T.); [email protected] (C.V.S.) 2 New York Presbitarian Brooklyn Methodist Hospital, New York, NY 11215, USA; [email protected] 3 Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; [email protected] 4 Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania 5 Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; [email protected] * Correspondence: [email protected] (V.S.); [email protected] (G.S.) Received: 27 March 2020; Accepted: 25 May 2020; Published: 28 May 2020 Abstract: Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period. -
Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal. -
The Digestive System
Connective tissue The Digestive System Part 1 Structure of digestive system Functions Basic Structure of the Alimentary Canal Wall Tube is made up of four layers: 1. Mucosa 2. Submucosa 3. Muscularis externa 4. Serosa (Peritoneum) or Adventitia Mucosa The innermost wall of the alimentary tube. Consists of: • Epithelium - usually simple columnar epithelium with goblet cells; may be stratified squamous if protection is needed (e.g. esophagus) • Lamina propria – loose connective tissue • Muscularis mucosae – takes part in the formation of folds Submucosa Made up of loose connective tissue. Contains submucosal (Meissner’s) nervous plexus and blood vessels, sometimes glands. Muscularis externa Usually two layers of smooth muscle: • inner circular layer • outer longitudinal layer. • Myenteric (Auerbach’s) nervous plexus in between • Responsible for peristalsis (controlled by the nerve plexus) Outer membrane • A serous membrane/peritoneum consisting of the mesothelium (simple squamous epithelium), and a small amount of underlying loose connective tissue. • Or adventitia consisting only of connective tissue is found where the wall of the tube is directly attached or fixed to adjoining structures (i.e., body wall and certain organs). Enteric nervous system The Alimentary Canal Pharynx Common respiratory and digestive pathway (both air and swallowed food and drinks pass through). • Stratified squamous non-keratinized epithelium • Lamina propria contains many elastic fibers • No muscularis mucosae • No submucosa • Striated muscle in the muscularis externa Esophagus Fixed muscular tube that delivers food and liquid from the pharynx to the stomach. Esophagus Epithelium - stratified squamous Mucosal and submucosal glands of the esophagus secrete mucus to lubricate and protect the luminal wall. Esophageal glands proper lie in the submucosa. -
Vestibule Lingual Frenulum Tongue Hyoid Bone Trachea (A) Soft Palate
Mouth (oral cavity) Parotid gland Tongue Sublingual gland Salivary Submandibular glands gland Esophagus Pharynx Stomach Pancreas (Spleen) Liver Gallbladder Transverse colon Duodenum Descending colon Small Jejunum Ascending colon intestine Ileum Large Cecum intestine Sigmoid colon Rectum Appendix Anus Anal canal © 2018 Pearson Education, Inc. 1 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 2 Upper lip Gingivae Hard palate (gums) Soft palate Uvula Palatine tonsil Oropharynx Tongue (b) © 2018 Pearson Education, Inc. 3 Nasopharynx Hard palate Soft palate Oral cavity Uvula Lips (labia) Palatine tonsil Vestibule Lingual tonsil Oropharynx Lingual frenulum Epiglottis Tongue Laryngopharynx Hyoid bone Esophagus Trachea (a) © 2018 Pearson Education, Inc. 4 Visceral peritoneum Intrinsic nerve plexuses • Myenteric nerve plexus • Submucosal nerve plexus Submucosal glands Mucosa • Surface epithelium • Lamina propria • Muscle layer Submucosa Muscularis externa • Longitudinal muscle layer • Circular muscle layer Serosa (visceral peritoneum) Nerve Gland in Lumen Artery mucosa Mesentery Vein Duct oF gland Lymphoid tissue outside alimentary canal © 2018 Pearson Education, Inc. 5 Diaphragm Falciform ligament Lesser Liver omentum Spleen Pancreas Gallbladder Stomach Duodenum Visceral peritoneum Transverse colon Greater omentum Mesenteries Parietal peritoneum Small intestine Peritoneal cavity Uterus Large intestine Cecum Rectum Anus Urinary bladder (a) (b) © 2018 Pearson Education, Inc. 6 Cardia Fundus Esophagus Muscularis Serosa externa • Longitudinal layer • Circular layer • Oblique layer Body Lesser Rugae curvature of Pylorus mucosa Greater curvature Duodenum Pyloric Pyloric sphincter antrum (a) (valve) © 2018 Pearson Education, Inc. 7 Fundus Body Rugae of mucosa Pyloric Pyloric (b) sphincter antrum © 2018 Pearson Education, Inc. -
The Small and Large Intestines∗
OpenStax-CNX module: m46512 1 The Small and Large Intestines∗ OpenStax College This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0y Abstract By the end of this section, you will be able to: • Compare and contrast the location and gross anatomy of the small and large intestines • Identify three main adaptations of the small intestine wall that increase its absorptive capacity • Describe the mechanical and chemical digestion of chyme upon its release into the small intestine • List three features unique to the wall of the large intestine and identify their contributions to its function • Identify the benecial roles of the bacterial ora in digestive system functioning • Trace the pathway of food waste from its point of entry into the large intestine through its exit from the body as feces The word intestine is derived from a Latin root meaning internal, and indeed, the two organs together nearly ll the interior of the abdominal cavity. In addition, called the small and large bowel, or colloquially the guts, they constitute the greatest mass and length of the alimentary canal and, with the exception of ingestion, perform all digestive system functions. 1 The Small Intestine Chyme released from the stomach enters the small intestine, which is the primary digestive organ in the body. Not only is this where most digestion occurs, it is also where practically all absorption occurs. The longest part of the alimentary canal, the small intestine is about 3.05 meters (10 feet) long in a living person (but about twice as long in a cadaver due to the loss of muscle tone). -
Short Bowel Syndrome with Intestinal Failure Were Randomized to Teduglutide (0.05 Mg/Kg/Day) Or Placebo for 24 Weeks
Short Bowel (Gut) Syndrome LaTasha Henry February 25th, 2016 Learning Objectives • Define SBS • Normal function of small bowel • Clinical Manifestation and Diagnosis • Management • Updates Basic Definition • A malabsorption disorder caused by the surgical removal of the small intestine, or rarely it is due to the complete dysfunction of a large segment of bowel. • Most cases are acquired, although some children are born with a congenital short bowel. Intestinal Failure • SBS is the most common cause of intestinal failure, the state in which an individual’s GI function is inadequate to maintain his/her nutrient and hydration status w/o intravenous or enteral supplementation. • In addition to SBS, diseases or congenital defects that cause severe malabsorption, bowel obstruction, and dysmotility (eg, pseudo- obstruction) are causes of intestinal failure. Causes of SBS • surgical resection for Crohn’s disease • Malignancy • Radiation • vascular insufficiency • necrotizing enterocolitis (pediatric) • congenital intestinal anomalies such as atresias or gastroschisis (pediatric) Length as a Determinant of Intestinal Function • The length of the small intestine is an important determinant of intestinal function • Infant normal length is approximately 125 cm at the start of the third trimester of gestation and 250 cm at term • <75 cm are at risk for SBS • Adult normal length is approximately 400 cm • Adults with residual small intestine of less than 180 cm are at risk for developing SBS; those with less than 60 cm of small intestine (but with a -
Small & Large Intestine
Small & Large Intestine Gastrointestinal block-Anatomy-Lecture 6,7 Editing file Objectives Color guide : Only in boys slides in Green Only in girls slides in Purple important in Red At the end of the lecture, students should be able to: Notes in Grey ● List the different parts of small intestine. ● Describe the anatomy of duodenum, jejunum & ileum regarding: (the shape, length, site of beginning & termination, peritoneal covering, arterial supply & lymphatic drainage) ● Differentiate between each part of duodenum regarding the length, level & relations. ● Differentiate between the jejunum & ileum regarding the characteristic anatomical features of each of them. ● List the different parts of large intestine. ● List the characteristic features of colon. ● Describe the anatomy of different parts of large intestine regarding: (the surface anatomy, peritoneal covering, relations, arterial & nerve supply) Small intestine The small intestine divided into : Fixed Part (No Mesentery): Free (Movable) Part (With Parts Duodenum* Mesentery): Jejunum & Ileum Shape C-shaped loop coiled tube Length 10 inches 6 meters (20 feet) Transverse Colon separates the Beginning At pyloro-duodenal junction at duodeno-jejunal flexure stomach/liver from the jejunum/ileum Termination At duodeno-jejunal flexure at ileo-ceacal flexure Peritoneal Covering Retroperitoneal mesentery of small intestine Divisions 4 parts --------- Foregut (above bile duct opening in 2nd part )& Midgut Embryological origin Midgut (below bile duct opening in 2nd part) So 2nd part has double -
Digestive System
Naziha Sultan Ahmed, BVMS, MSc Scientific degree (Assis. Prof.), Department of Anatomy College of Veterinary Medicine, University of Mosul, Mosul, Iraq https://orcid.org/0000-0002-2856-8277 https://www.researchgate.net/profile/Naziha_Ahmed Anatomy | Part 18| 2nd year 2019 Digestive System Fixation of the liver (Ligaments of the liver): 1-Lesser omentum: consist of two parts: a/Hepatogastric ligament: connect between hepatic porta and lesser curvature of the stomach . b/Hepatoduodenal ligament: connect between hepatic porta and the cranial part of the duodenum. 2-Coronary ligament: connect between the parietal (diaphragmatic ) surface of liver, with the diaphragm and the caudal vena cava. 3-Falciform ligament: connect between the notch of round ligament in the liver and the sternal part of the diaphragm. 4-Round ligament: the residue (remnants) of the umbilical vein of the fetus. 5-Hepatorenal ligament: connect between the right lobe of liver and the right kidney. 6-Right & left triangular ligaments: connect between the dorsal border of right and left lobes of the liver and the diaphragm . Both ligaments continue medially with the coronary ligament. CouAnatomy | Digestive system | Assis. Prof. Naziha Sultan Ahmed Page | 1 The pancreas: Pancreas has V-shape. It consists of base and two limbs (right & left limbs). *In horse: large pancreas body perforated by portal vein and long left limb, with short right limb (because of large size of cecum in horse ). The horse pancreas has two ducts: 1-Chief pancreatic duct: opens with bile duct at the major duodenal papilla. 2-Accessory pancreatic duct: opens at the minor duodenal papilla. *In dog: pancreas notched by the portal vein. -
Nomina Histologica Veterinaria, First Edition
NOMINA HISTOLOGICA VETERINARIA Submitted by the International Committee on Veterinary Histological Nomenclature (ICVHN) to the World Association of Veterinary Anatomists Published on the website of the World Association of Veterinary Anatomists www.wava-amav.org 2017 CONTENTS Introduction i Principles of term construction in N.H.V. iii Cytologia – Cytology 1 Textus epithelialis – Epithelial tissue 10 Textus connectivus – Connective tissue 13 Sanguis et Lympha – Blood and Lymph 17 Textus muscularis – Muscle tissue 19 Textus nervosus – Nerve tissue 20 Splanchnologia – Viscera 23 Systema digestorium – Digestive system 24 Systema respiratorium – Respiratory system 32 Systema urinarium – Urinary system 35 Organa genitalia masculina – Male genital system 38 Organa genitalia feminina – Female genital system 42 Systema endocrinum – Endocrine system 45 Systema cardiovasculare et lymphaticum [Angiologia] – Cardiovascular and lymphatic system 47 Systema nervosum – Nervous system 52 Receptores sensorii et Organa sensuum – Sensory receptors and Sense organs 58 Integumentum – Integument 64 INTRODUCTION The preparations leading to the publication of the present first edition of the Nomina Histologica Veterinaria has a long history spanning more than 50 years. Under the auspices of the World Association of Veterinary Anatomists (W.A.V.A.), the International Committee on Veterinary Anatomical Nomenclature (I.C.V.A.N.) appointed in Giessen, 1965, a Subcommittee on Histology and Embryology which started a working relation with the Subcommittee on Histology of the former International Anatomical Nomenclature Committee. In Mexico City, 1971, this Subcommittee presented a document entitled Nomina Histologica Veterinaria: A Working Draft as a basis for the continued work of the newly-appointed Subcommittee on Histological Nomenclature. This resulted in the editing of the Nomina Histologica Veterinaria: A Working Draft II (Toulouse, 1974), followed by preparations for publication of a Nomina Histologica Veterinaria. -
Layers of the Wall of the Digestive Tract
Layers of the wall of the digestive tract The layers of the digestive tract are 1-the mucosa, 2-submucosa, 3-muscularis externa, 4-serosa/adventitia. These layers are described from the lumen outward, and they form the general plan of the digestive tract . Regions of the digestive tract Esophagus The esophagus is a short, muscular tube whose lumen is usually collapsed unless a bolus of food is traversing its length for delivery from the pharynx into the stomach. 1- mucosa: A: stratified squamous nonkeratinized epithelium B: lamina propria: loose type of connective tissue C: muscularis mucosae composed only of longitudinally oriented smooth muscle fibers. 2- submucosa: dense irregular collagenous connective tissue interspersed with elastic fibers + glands (the mucus-producing esophageal glands proper). 3- muscularis externa: thinner circular and outer longitudinal layers. Those in the proximal (upper) one-third are skeletal; those in the middle one-third are skeletal and smooth, whereas those in the distal (lower) one- third are smooth muscle. 4- adventitia: loose c.t , nerve and blood vessels. 1 2 3 4 Stomach(fundic region) 1- mucosa A: epithelium simple columnar whose surface lining cells produce a mucous substance that coats and protects the stomach lining from the low pH environment and from autodigestion. B- lamina propria: c.t. + gastric glands (parietal cells, chief cells, mucous neck cells, surface lining cells) C- muscularis mucosa consist of two layers 2-sub mucosa: wide layer of c.t 3-muscularis externa consist of three layers. 4-serosa consist of mesothelium Pyloric region The mucosa of the pyloric antrum possesses deep gastric pits and gastric glands. -
A HISTOLOGICAL STUDY of HUMAN FOETAL GALLBLADDER Kalpana Thounaojam*1, Ashihe Kaini Pfoze 1, N
International Journal of Anatomy and Research, Int J Anat Res 2017, Vol 5(4.3):4648-53. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2017.427 A HISTOLOGICAL STUDY OF HUMAN FOETAL GALLBLADDER Kalpana Thounaojam*1, Ashihe Kaini Pfoze 1, N. Saratchandra Singh 2, Y. Ibochouba Singh 2. *1Associate Professor, Department of Anatomy, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India 2 Professor, Department of Anatomy, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India ABSTRACT Background: The wall of human gallbladder is composed of three layers: mucous membrane(mucosa), fibromuscular layer, adventitia (and serosa). Heterotopic tissues in the gallbladder include liver parenchymal nodules suspended in gallbladder by a mesentery, gastric mucosa and pancreatic tissue. There are not many literature on the histological development of human foetal gallbladder. The study was aimed at conducting an utmost effort on analyzing the histological layers of human foetal gallbladder at different gestational ages. Materials and Methods: 100 fresh fetuses, of different age groups varying from 15 weeks to 40 weeks which are products of terminated pregnancy under Medical Termination of Pregnancy (MTP) Act of India,1971 and stillbirths are obtained from the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences,Imphal. The histology of foetal gallbladder are analysed in the present study by staining the sections prepared with haematoxylin and eosin, Van Gieson’s, Masson’s Trichrome and Verhoeff’s haematoxylin elastic tissue stains. Result: In the present study, three histological layers of gallbladder viz., mucosa, fibromuscular layer and adventitia(and serosa) can be clearly demarcated from 18-week old foetuses onwards. -
The Gallbladder
The Gallbladder Anatomy of the gallbladder Location: Right cranial abdominal quadrant. In the gallbladder fossa of the liver. o Between the quadrate and right medial liver lobes. Macroscopic: Pear-shaped organ Fundus, body and neck. o Neck attaches, via a short cystic duct, to the common bile duct. Opens into the duodenum via sphincter of Oddi at the major duodenal papilla. Found on the mesenteric margin of orad duodenum. o 3-6 cm aboral to pylorus. 1-2cm of distal common bile duct runs intramural. Species differences: Dogs: o Common bile duct enters at major duodenal papilla. Adjacent to pancreatic duct (no confluence prior to entrance). o Accessory pancreatic duct enters at minor duodenal papilla. ± 2 cm aboral to major duodenal papilla. MAJOR conduit for pancreatic secretions. Cats: o Common bile duct and pancreatic duct converge before opening at major duodenal papilla. Thus, any surgical procedure that affects the major duodenal papilla can affect the exocrine pancreatic secretions in cats. o Accessory pancreatic duct only seen in 20% of cats. 1 Gallbladder wall: 5 histologically distinct layers. From innermost these include: o Epithelium, o Submucosa (consisting of the lamina propria and tunica submucosa), o Tunica muscularis externa, o Tunica serosa (outermost layer covers gallbladder facing away from the liver), o Tunica adventitia (outermost layer covers gallbladder facing towards the liver). Blood supply: Solely by the cystic artery (derived from the left branch of the hepatic artery). o Susceptible to ischaemic necrosis should its vascular supply become compromised. Function: Storage reservoir for bile o Concentrated (up to 10-fold), acidified (through epithelial acid secretions) and modified (by the addition of mucin and immunoglobulins) before being released into the gastrointestinal tract at the major duodenal.