ANATOMY OF GASTROINTESTINAL SYSTEM

Rahmadini Djalal-Boultby, MD, MBiomed

Department of Anatomy
Faculty of Medicine Universitas Indonesia

Disampaikan pada kuliah di Fakultas Kedokteran Universitas Kristen Indonesia

JAKARTA, 29 Maret 2014
 OVERVIEW

• Alimentary Canal
• Accessory digestive organs
• Blood supplies, Lymphatics, Innervation
• Abdominal wall
• Abdomen surface anatomy
 GASTROINTESTINAL SYSTEM

Alimentary Canal Accessory Digestive

Mouth Organs

Pharynx  Teeth

Esophagus  Tongue

Stomach  Digestive glands:

salivary glands, liver,
Small Intestine gallbladder, pancreas
Large Intestine
Anus
 THE MOUTH
• Boundaries:
• Anterior: lips
• Lateral: cheeks
• Superior: palate
• Inferior: tongue
• Posterior: fauces of the
oropharynx ( isthmus faucium)
• Divided into:
• The vestibule (vestibulum oris)
• Proper Oral Cavity (cavitas
oris propria
ORAL CAVITY
 ORAL CAVITY
PROPER ORAL CAVITY
Roof:
• Anterior: hard palate (palatum
durum)
• Posterior: soft palate (palatum
molle)
Floor:
• 2/3 anterior of tongue
• gum (mandible side)
ORAL VESTIBULE
• Area between the teeth
(internal border) with cheeks
& lips(external border).
• Lateral wall  buccinator
muscle & mucosa
• Opposite to the upper Molar 2
 opening of the parotid duct
 PHARYNX
Sagittal view
• A funnel-shaped tube
extends from the internal
nares to the esophagus
(posteriorly) & the larynx
(anteriorly)
• Divided into:
• Nasopharynx
• Oropharynx
• Laryngopharynx

Gray’s Anatomy for students.

Elsevier, 2005
PHARYNX
Oropharynx
 Roof : soft palate & pharyngeal
isthmus
 Floor : 1/3 posterior of the tongue
 Anterior wall : opens into the
mouth through oropharyngeal
isthmus
 Lateral walls : palatoglossal &
palatopharyngeal arches
 Posterior wall : body of 2 nd
cervical vertebra & upper part of
the body of 3 rd cervical vertebra
Laryngopharynx
 Anterior wall : inlet of the larynx
& mucous membrane covering
the posterior surface of the
larynx
 Posterior wall : supported by the
bodies of the 3 rd, 4th, 5th & 6th
cervical vertebrae
 Lateral wall : thyroid cartilage
and the thyrohyoid membrane
PHARYNX
Posterior view  Pharyngeal recesses
 Palatopharyngeal arch/
arcus
palatopharyngeus
 Vallecula epiglottica
 Piriform fossa/
recessus piriformis

Gray’s Anatomy for

students. Elsevier, 2005
PHARYNX
• Pharyngeal recess: a small depression in the lateral wall behind the tubal
elevation
• Palatopharygeal arch : a fold of mucous membrane on the lateral wall of the
oral part of the pharynx (behind palatoglossal arch)
• Vallecula epiglottica : the depression on each side of the median
glossoepiglottic fold
• Piriform fossa : a recess of mucous membrane situated on either side of the
entrance of larynx. It is bounded medially by aryepiglottic folds and laterally
by thyroid cartilage  a common site for the lodging sharp ingested bodies
(fish bones, etc)
 EXTERNAL CIRCULAR LAYER OF PHARYNGEAL
MUSCLES
Posterior view

Constrictors muscles
Superior constrictor
muscle
compress the lumen of the
pharynx involuntarily during
swallowing Middle constrictor
muscle

Inferior constrictor
muscle
Nerve supply: pharyngeal plexus
(branches of the
glossopharyngeal, vagus and
sympathetic nerves)

Source: Van De Graaff. Human Anatomy. 6th ed. McGraw Hill.2001

ESOPHAGUS
• A muscular, collapsible tube,
± 25 cm long
• Begins at the inferior end of
the laryngopharynx
• Posterior to trachea
• Pierces the diaphragm
through Esophageal hiatus
 ESOPHAGEAL
CONSTRICTIONS

• At site where the pharynx joins

with the upper part of
esophagus
• The arch of aorta crosses it
anteriorly
• The left main bronchus crosses
it anteriorly
• At site where it passes through
diaphragm
STOMACH
• The dilated portion of the
alimentary canal
• J-shaped
• Four parts of stomach:
 Cardia
 Fundus
 Corpus
 Pylorus
• Two curvatures:
 Greater curvature
 Lesser curvature
STOMACH

• Covered by peritoneum,
except where blood vessels
run along its curvatures &
small area posterior to the
cardiac orifice
• Lesser omentum
• Greater omentum
• Muscular wall → longitudinal
fibers, circular fibers, oblique
fibers
INTERIOR OF THE STOMACH

• Cardiac orifice
• Pyloric orifice →
m.sphincter pylori
• Gastric folds (plica
gastrica)
• Gastric canal
(maagenstrasse
Waldeyer)
 SMALL INTESTINES

• The longest part of the

alimentary canal, extends
from the pylorus to the
ileocaecal junction
• Hollow tube, ± 6-7 m long
• Consist of:
 Duodenum
 Jejunum
 Ileum
 DUODENUM

• C-Shaped tube, ± 10
inches (25 cm) long
• Situated in the epigastric
& umbilical regions
• Divided into 4 parts
 Superior part
 Descending part
 Inferior part
 Ascending part
• Retroperitoneal, except
its beginning

Ligament of Treitz → duodenojejunal flexure

JEJUNUM & ILEUM

• Jejunum (proximal
2/5 of jejunum-
ileum; mostly in left
upper quadrant)

• Ileum (distal 3/5 of

jejunum-ileum;
mostly in right
lower quadrant)
CHARACTERISTICS OF JEJUNUM & ILEUM

Or “windows”

Mesentery of jejunum
Mesentery of ileum
CHARACTERISTICS OF JEJUNUM & ILEUM
Characteristics Jejunum Ileum
Location Upper left quadrant Lower right quadrant
Diameter 2 – 4 cm 2 – 3 cm
Lumen Wider Narrower
Walls Thicker and more vascular Thinner and less vascular
Circular mucosal folds
Larger and more closely set Smaller and sparse
(plicae circulares)
Windows present No windows
Fat less abundant Fat more abundant
Mesentery Arterial arcade, 1 or 2 Arterial arcades, 3-6
Vasa recta shorter & more
Vasa recta, longer & fewer
numerous
Lymphoid nodules
absent present
(Peyer’s Patches)
VASA RECTA & ARCADES OF JEJUNUM & ILEUM

Source: McMinn’s Colour Atlas of Human Anatomy. Fifth edition. Toronto. 2003
 MUCOSA OF SMALL INTESTINES

jejunum ileum

Source: http://www.kcvl.cz/atlas/278.jpg Source: http://www.kcvl.cz/atlas/281.jpg

LARGE INTESTINE
• Extends from the ileum
to the anus
• ± 1,5 m long
• Consists of:
 Caecum & appendix
vermiformis
 Colon
 Rectum
 Anal canal
• Characteristics: haustra,
taenia coli, appendices
epiploicae, semilunar
folds
CAECUM

• a blind-ended pouch, ± 6 cm long, intraperitoneal structure,

• Situated in right iliac fossa
• Ileocecal valve : a fold of mucous membrane at the junction of small
intestine & large intestine
 APPENDIX VERMIFORMIS

• The appendix: narrow, hollow tube.

• Connected to cecum at the
posteromedial wall of caecum;
Appendicitis
2 cm inferior of ileocecal valve
• Suspended by mesoappendix. Mc Burney’s Point
COLON
• Ascending colon
• Transverse colon  Hepatic flexure

• Descending colon  Splenic flexure

• Sigmoid colon
 Ascending & descending colon
 retro peritoneal
 Transverse & sigmoid colon 
intraperitoneal
SIGMOID COLON
• Begins above the pelvic inlet
& extends to the vertebra
Sacralis III
• The S-shaped, 25 – 38 cm
long
• Attached to the posterior
pelvic wall by sigmoid
mesocolon
RECTUM

• ± 13 cm long
• Begins at the level of
vertebra SIII, at the
rectosigmoid junction.
• Location: posterior part of
lesser pelvis, in front of
the 3 pieces of lower
sacrum & coccyx
• Retroperitoneal position
ANAL CANAL

• The last subdivision of the large intestines, ± 3 cm long

• Upper part: anal column, anal sinus, pectinate line
• Middle part: between pectinate line & anocutaneus line
• Lower part: external anal sphincter & internal anal sphincter
ANAL CANAL
Upper half of Anal Canal
 Nerve supply: from autonomic
hypogastricus plexuses  sensitive
only to stretch
 Arterial supply : a. rectalis superior
 Venous drainage : v. rectalis
superior (mainly)
 Lymphatic drainage: upward along
a. rectalis superior  pararectal
nodes  inferior mesenteric nodes
Pectinate line: indicates the level where the upper half of the anal
canal joins the lower half
Lower half of Anal Canal
 Nerve supply : from somatic inferior
rectal nerve  sensitive to pain,
temperature, touch & pressure
 Arterial supply : a. rectalis inferior
 Venous drainage : v. rectalis inferior
 v. pudenda interna  v. illiaca
interna
 Lymphatic drainage : downward to
the medial group of superficial
inguinal nodes
Anal canal
 TEETH

INCISOR

CANINE

PREMOLAR

MOLAR

Source: Marieb & Mallat

TEETH
• All teeth are supplied by
indirect or direct branches of
the Maxillary artery
• Upper teeth ← posterior
superior alveolar & anterior
superior alveolar arteries
• Lower teeth ← inferior alveolar
artery
• All nerves that innervate the
teeth and gums (gingivae) are
branches of the trigeminal
nerve (n. V)
TONGUE
• Forms part of the floor of the
oral cavity.
• Separated into 2/3 anterior
and 1/3 posterior of tongue by
a V-shaped terminal sulcus of
tongue.
• The terminal sulcus forms the
inferior of the oropharyngeal
isthmus, between oral and
pharyngeal cavity.
• Papillae: filiform, fungiform,
vallate, foliate.
TONGUE
MUSCLES OF THE TONGUE
• Extrinsic muscle, originate
outside of the tongue and
insert to the tongue:
genioglossus, hyoglossus,
styloglossus & palatoglossus
muscles
• Intrinsic muscle, originate
and insert within the
tongue: superior &
inferior longitudinal,
transverse & vertical
muscles.
 SALIVARY GLANDS

• Opens into oral cavity

Parotid duct
• Divide into: intrinsic &
extrinsic salivary glands
• Intrinsic salivary
glands: glands of
Parotid gland tongue, palate, lips, &
cheeks
Sublingual gland
Submandibular
gland
• Extrinsic glands:
parotid, submandibular,
Sublingual duct Submandibular duct
and sublingual glands
PAROTID GLAND
• The parotid duct across
the external surface of
masseter muscle &
penetrates buccinator
muscle.

• It opens into oral cavity

adjacent to the crown of
upper molar 2
SUBMANDIBULAR & SUBLINGUAL GLANDS
SUBMANDIBULAR GLANDS
• Divided into 2 arms: the larger
(superficial) and the smaller arm (deep)
by mylohyoid muscle.
• Submandibular ducts drains into oral
cavity, lateral to the base of frenulum of
the tongue
SUBLINGUAL GLANDS
• Location: on sublingual fossa, lateral to
submandibular ducts
• Superior margin of the glands raises an
elongate fold of mucosa  sublingual
folds.
• Sublingual ducts opens on to sublingual
folds
 LIVER

• Location: right
hypochondrium & epigastric
region or right upper
quadrant
• Surfaces:
• Diaphragmatic surface:
anterior, superior &
posterior direction
• Visceral surface: inferior
direction. Covered by
visceral peritoneum
except in the fossa for
gallbladder & at the porta
hepatis.
LIVER
• Lobes: divided into left & right
lobes by the gallbladder &
• Ligaments:
inferior vena cava. Includes
caudate lobe on the upper
part and quadrate lobe on the
lower part of liver.
• Bare area of liver: an area
between the liver & diaphragm
which is devoid of peritoneum
• Falciform ligament
• Round ligament of liver:
• Triangular ligament( left &
right
• Coronary ligament (anterior
& posterior)
• Hepatogastric ligament
• Hepatoduodenal ligament
LIVER

Porta hepatis : an area near the center of visceral surface → “gateway

to the liver” ← for: the portal vein, the hepatic arteries, the hepatic ducts
VASCULATURE OF LIVER

Source : Moore, K.L. Clinically Oriented Anatomy. Fifth Edition. Lippincott Williams & Wilkins. Tokyo. 2006
GALLBLADDER

Parts of gallbladder:
• Fundus: may project from
the inferior border of liver
• Body of gallbladder.
• Neck of gallbladder.
• Duct: cystic duct
• Hepatic duct & cystic duct
open to common bile duct
(ductus coledochus) and
drains to descending part
of duodenum.
PANCREAS
• Extends across the posterior
abdominal wall from the
duodenum (on the right) to the
spleen (on the left)
• Location: posterior to the
stomach, retroperitoneal.
• It consist:
• The head
• The uncinate process:
• The neck
• The body
• The tail
 INTERIOR OF PANCREAS
Ductus pancreaticus

Duodenal papilla of Vater

• Pancreatic ducts:
• Major pancreatic duct : begins in the tail of the pancreas. The main
pancreatic duct join the bile duct and forms the papilla of Vater
• Minor pancreatic duct: drains into the duodenum, above the major
duodenal papilla at the minor duodenal papilla
 ANTERIOR BRANCHES OF THE ABDOMINAL AORTA

The gastrointestinal viscera

and associated organs are
Celiac trunk
supplied by the anterior
Superior mesenteric branches of the abdominal
artery

Abdominal aorta
aorta:
Inferior mesenteric artery
 Celiac artery
 Superior mesenteric artery
 Inferior mesenteric artery
ARTERIAL SUPPLY OF THE GASTROINTESTINAL
TRACT

• Celiac artery (celiac trunk) →

abdominal part of esophagus, stomach,
upper 1 ½ parts of duodenum up to
duodenal papilla of Vater, liver, common
bile duct, pancreas, spleen

• Superior mesenteric artery →

Lower 2 ½ part of duodenum below the
duodenal papilla of Vater, jejunum, ileum,
cecum, appendix , ascending colon, right of
2/ transverse colon
3

• Inferior mesenteric artery → Left

of 1/3 transverse colon ,descending colon,
sigmoid colon, rectum, upper part of the
anal canal above the pectinate line.
 Left gastric artery
Splenic artery

Celiac
Common hepatic artery
trunk

CELIAC TRUNK AND ITS BRANCHES

SPLENIC ARTERY AND ITS BRANCHES

Short gastric artery

Gastro-omenta
(Gastroepiploic) artery

Splenic artery
COMMON HEPATIC ARTERY AND ITS BRANCHES
Right hepatic artery

Left hepatic artery

Proper hepatic artery

Gastroduodenal artery
Common hepatic artery

Right gastric artery

SUPERIOR MESENTERIC ARTERY
& ITS BRANCHES

MIDDLE COLIC ARTERY

INFERIOR PANCREATICODUODENAL ARTERY
SUPERIOR MESENTERIC ARTERY

RIGHT COLIC ARTERY JEJUNUM

JEJUNAL ARTERIES

ILEOCOLIC
ARTERY

ILEAL ARTERIES

APPENDICULAR ARTERIES
INFERIOR MESENTERIC ARTERY
& ITS BRANCHES

LEFT COLIC ARTERY

INFERIOR MESENTERIC ARTERY

SUPERIOR RECTAL ARTERY

SIGMOID ARTERIES
VENOUS DRAINAGE OF THE ABDOMINAL PORTION OF THE GASTROINTESTINAL
TRACT
VENOUS DRAINAGE
OF THE GASTROINTESTINAL VISCERA AND ASSOCIATED
ORGANS
• Venous drainage from the spleen, pancreas, gallbladder,
and the abdominal part of the gastrointestinal tract
(except for the inferior part of the rectum)

PORTAL VEIN
PORTAL VEIN
• Venous blood from stomach, duodenum, jejunum, ileum colon,
rectum, pancreas, gallbladder & spleen enters the liver through
hepatic portal vein  sinusoids of liver  hepatic veins  drains
into inferior vena cava  enters the right atrium of the heart.

• Formed by the union of the splenic vein & superior mesenteric

vein, at the level of the vertebra Lumbalis II.

• Course: passed posterior to the superior part of the duodenum &

enters the hepatic portal vein with the bile duct & proper hepatic
artery.
PORTAL VEIN

PORTAL
VEIN

SPLENIC VEIN
INFERIOR MESENTERIC VEIN
SUPERIOR MESENTERIC VEIN

60
 PORTOCAVAL SYSTEM
• Anastomosis (communication) between portal vein (portal system) with the vena
cava (caval system).
• Forms collateral circulation in portal obstruction.
• Important sites:
• Abdominal part of the esophagus:
• esophageal tributaries of the left gastric vein (portal) with esophageal tributaries of
the azygos & hemiazygos veins (systemic)
• Umbilicus
• paraumbilical veins (portal) & epigastric veins (systemic)
• Bare area of liver
• hepatic venules (portal) with the intercostal veins & phrenic vein (systemic)
• Posterior abdominal wall
• Veins of retroperitoneal organs (portal) with the retroperitoneal veins of the
abdominal wall & the renal capsule (systemic)
• Anal canal
• superior rectal vein (portal) with the middle rectal & inferior rectal veins (systemic)

61
PORTOCAVAL SYSTEM
Tributaries to azygos vein

V. PORTA

ROUND LIG. (LIG. TERES HEPATIS)

&.PARAUMBICAL VEINS

Superficial veins on
abdominal wall
INFERIOR VENA CAVA

SUPERIOR RECTAL VEIN

INFERIOR RECTAL VIEN

PORTOCAVAL SYSTEM

Portal vein obstruction  portal hypertension

• Caput medusae  at the umbilicus
• Esophageal varices  at the gastroesophageal
junction
• Haemorrhoids  at the anorectal junction
LYMPHATICS
• Lymphatic vessels & nodes of the gastrointestinal tract & associated organs  pre
aortic lymph nodes
• Almost all the lymphatic vessels of the gastrointestinal viscera & associated organs
drained to thoracic duct
• Run with arteries of the gastrointestinal viscera
• Pre aortic lymph nodes contains :
• Celiac nodes (nn.ll.coeliacus) :
• Receive lymph from the foregut origin: gastric (nn.ll. gastrica), hepatic (nn.ll. Hepatica) &
pancreaticosplenic (nn.ll. Pancreaticolienalis) nodes
• Also receive lymph from superior & inferior mesenteric nodes

• Superior mesenteric nodes (nn.ll. Mesenterica superior):

• Receive lymph from the midgut origin: Mesenteric nodes, ileocolic nodes
• Also receive lymph from inferior mesenteric nodes.
• Drains to celiac nodes

• Inferior mesenteric nodes (nn.ll. mesenterica superior):

• Receive lymph from descending & sigmoid colon, superior part of the rectum, superior part of
the canal anal.
• Drains to superior mesenteric nodes
 CELIAC & SUPERIOR MESENTERY NODES

NN.LL.COELIACUS

NN.LL.GASTRICUS
NN.LL.PANCREATICOLIENALIS

SUPERIOR MESENTERIC NODES

SUPERIOR & INFERIOR MESENTERIC NODES
INNERVATION
Parasymphatetic :
• Increase peristaltic movement
• Increase secretion of the digestive glands

Symphatetic :
• Inhibitory to peristalsis
• Increase contraction of the sphincter muscle
INNERVATION

PARASYMPATHETIC
Center : craniosacral
Dorsal nuclei N.X 
esophagus, stomach, liver,
pancreas, duodenum,
jejunum, ileum, ascending
colon , proximal 2/3 of
transverse colon
Sacral 2-4  1/3 proximal
transverse colon, rectum,
anus
 INNERVATION
SYMPHATETIC Stomach
Duodenum
Pancreas
Center : thoracolumbal Spleen
Liver
Prevertebral ganglion :
Jejunum, ileum, ascending colon,
• Celiac ganglion proximal 2/3 of the transverse
colon

• Superior mesenteric ganglion

Distal 1/3 of the transverse
• Inferior mesenteric ganglion colon, sigmoid colon, rectum,
anus

Urinary bladder
Genital organs
ABDOMINAL WALL
• Boundaries:
• Superior: xyphoid process &
costal margin
• Posterior: vertebral column
• Inferior: upper parts of the
pelvic bones.
• Its layers consist of: skin,
subcutaneous tissue, muscles,
extraperitoneal fascia, parietal
peritoneum
• Superficial fascia:
- Camper’s fascia
Layers of the abdominal wall
- Scarpa’s fascia
ABDOMINAL WALL
MUSCLES AND SHEATS OF ABDOMINAL WALL
• Muscles of anterior abdominal
wall:
Flat muscles:
• External oblique
• Internal oblique
Tendinous
Transverse • Transverse abdominal
intersection
abdominal
Vertical muscles:
Internal Linea alba
oblique • Rectus abdominis
External • Pyramidalis
oblique Rectus • Sheath and aponeurosis.
abdominis
• Linea alba: attachment of
deep layer of superficial
fascia and the three
aponeurosis
 ORGANIZATION OF THE RECTUS SHEATH

• Rectus sheath formed by a layering of the aponeuroses of external and internal oblique, and
transverse abdominal muscle.
• The pattern of upper three quarter of the sheath of rectus abdominis muscle:
• The anterior wall: aponeurosis of external oblique, half of the aponeurosis of internal oblique.
• The posterior wall: half of the aponeurosis of internal oblique and the aponeurosis of transverse
abdominal muscles.
• The pattern of lower one-quarter:
• The anterior wall: contains all of the aponeurosis.
• The posterior wall: contains no aponeurosis. From this point inferiorly, rectus abdominis muscle is in
contact with transversalis fascia. And forms a line: linea arcuata (arcuate line).
Internal aspect of anterolateral abdominal wall
INGUINAL REGION
• Inguinal ligament
• Inguinal canal
• Superficial inguinal ring
(annulus inguinalis medialis/
superficial)
• Deep inguinal ring (annulus
inguinalis lateralis
/profundus)
• Conjoint tendon
• Structures passing through
the canal (Male & Female)

Inguinal Hernias:
direct & Indirect
STRUCTURES IN INGUINAL REGION
• Inguinal ligament : the lower border of the aponeurosis of External oblique
muscle that folded backward on itself. It extends from ASIS – pubic tubercle
• Inguinal canal : an oblique passage through the lower part of the anterior
abdominal wall
• Deep inguinal ring : an oval opening in the fascia transversalis, lies about
1.3 cm above the inguinal ligament midway between ASIS & symphysis
pubis
• Superficial inguinal ring : a triangular-shaped defect in the aponeurosis of the
External oblique muscle and lies immediately above and medial to the pubic
tubercle
• Conjoint tendon : the lowest tendinous fibers of the Internal oblique muscle
that joined with the lowest fibers from the Transversus abdominis muscle
 CANALIS INGUINALIS (MALE)

Inguinal ligament

Deep inguinal ring

Spermatic cord in inguinal

canal

Superficial inguinal ring

Spermatic cord in scrotum

CANALIS INGUINALIS (FEMALE)
PERITONEUM
A membrane that lines the walls of
the abdominal cavity and covers
much of the viscera. Divided into:
• Parietal peritoneum : lines the
inner surface of abdominal &
pelvic walls, & the lower
surface of diaphragm.
• Visceral peritoneum: lines the
outer surface of the organs.

Peritoneal folds: suspend the

organs; in the peritoneal cavity 
intraperitoneal
Organs outside the peritoneal
cavity, with only one surface or
part covered by peritoneum 
retroperitoneal
PERITONEUM
• Mesenterium : is a double layer of peritoneum that occurs as a result of the
invagination of peritoneum by an organ and constitutes a continuity of
parietal and visceral peritoneum
• Omentum : is a double-layered extension of peritoneum passing from
stomach and proximal part of duodenum to adjacent organs.
• The greater omentum (gastrophrenic, gastrosplenic & gastrocolic ligaments)
: extends superiorly, laterally to the left and inferiorly from greater curvature
of stomach and the proximal part of duodenum
• The lesser omentum (hepatogastric & hepatoduodenal ligaments): connects
the lesser curvature of stomach and the proximal part of duodenum to the
liver
PERITONEUM

• Peritoneal cavity: potential space

enclosed within the peritoneum.
• The peritoneal cavity is divided
into:
• The greater sac
• The omental bursa

Connected by Omental Foramen

ABDOMEN SURFACE ANATOMY
 ABDOMINAL REGIONS AND QUADRANTS

Midclavicular plane

Subcostal plane

Transtubercular
plane

(a) (b)

Divisions of the anterior abdominal wall for mapping the digestive organs
into abdominal cavity
(a) The nine surface regions of the anterior abdominal wall
(b) The abdominal viscera as they relate to the nine surface
APPENDICES
MASTICATION MUSCLES

Temporalis Lateral pterygoid

Masseter
Medial pterygoid
 MUSCLES OF PHARYNX AND TONGUE

Tensor veli palatini

Styloglossus
Levator veli palatini

Superior pharyngeal
constrictor

Middle pharyngeal
constrictor
Hyoglossus
Inferior pharyngeal
constrictor

Genioglossus
MASTICATION MUSCLES
Muscle Nerve supply Action
Masseter Mandibular nerve Prime mover of jaw closure, elevates
mandible
Temporalis Mandibular nerve Closes jaw, elevates and retracts mandible,
maintains position of mandible at rest
Medial pterygoid Mandibular nerve Acts with lateral pterygoid to protract
mandible and for grinding movement
(synergists with masseter & temporalis in
elevation of mandible)
Lateral pterygoid Mandibular nerve Grinding movement, protracts mandible
(pulls it anteriorly)
MUSCLES OF PHARYNX
Muscle Nerve supply Action
Tensor veli palatini Nerve to medial Tenses soft palate
pterygoid from n. V3
Levator veli palatini Pharyngeal plexus Raises soft palate
Superior pharyngeal Pharyngeal plexus Aids soft palate in closing off nasopharynx,
constrictor propels bolus downward
Middle pharyngeal Pharyngeal plexus Propels bolus downward
constrictor
Inferior pharyngeal Pharyngeal plexus Propels bolus downward
constrictor
MUSCLES OF TONGUE
Muscle Nerve supply Action

Genioglossus n. XII Protrudes apex of tongue through mouth

Hyoglossus n. XII Depresses tongue

Styloglossus n. XII Draws tongue upward and backward

Palatoglossus Pharyngeal plexus Pulls roots of tongue upward and backward,

narrow oropharyngeal isthmus
CAPUT MEDUSAE
The distended subcutaneous veins radiate out from the
umbilicus

Source: http://www.nejm.org/doi/full/10.1056/NEJMicm050651
HEMORRHOIDS

Source: http://www.onhealth.com/hemorrhoids/article.htm
HERNIA
 the protrusion of part of the abdominal contents beyond the normal confines
of the abdominal wall.
 Consists of three parts: the sac, the contents of the sac, and the covering of
the sac
 Hernial contents : may consist of any structure found within the abdominal
cavity
 Hernial coverings : formed by the layers of the abdominal wall through which
the hernial sac passes
HERNIA INGUINALIS
 REFERENCES
• Marieb, E.N., Mallat, J. Human Anatomy. Third Edition. Benjamin
Cummings. Toronto. 2001
• Snell, R.S., Clinical Anatomy. Seventh Edition. Lippincott Williams
& Wilkins. Tokyo. 2004
• Drake, R.L., Vogl, W., Mitchell, A.W.M., Gray’s Anatomy for
Students. Elsevier Churchill Livingstone. Toronto. 2005
• Moore, K.L. Clinically Oriented Anatomy. Fifth Edition. Lippincott
Williams & Wilkins. Tokyo. 2006

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