UNIT – VIII

DIGESTIVE SYSTEM

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 Digestive system
Parts of digestive system
Mouth , pharynx, esophagus, stomach, small intestine and large intestine.
Accessory glands are salivary glands ( parotid, submandibular and sublingual glands ), liver,
pancrease and gall bladder.

MOUTH

It is the first part of digestive system. It extends from lips to oropharyngeal isthmus. It is divided into
two parts
1. Vestibule – it is a small space between lips, cheeks and gums with teeth.
2. Oral cavity proper – it is a large space inside the teeth and gums called oral cavity proper. It contain
tongue.

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 SALIVARY GLANDS

There are three pairs of large salivary glands. Namely parotid, submandibular and sublingual glands.
The secretion of these glands are carried by their ducts in to the oral cavity, which is concerned with
the digestion.
1. PAROTID GLAND
It is the largest salivary gland and it is serous gland.
Situation : Infront and below the external acoustic meatus.
Shape : Inverted pyramidal
External features and relations
1. Apex : Is directed downwards towards the neck. Through which leaves retromandibular vein and
cervical branch of facial nerve.
2. Base : Is related to external acoustic meatus. Through which leaves auriculotemporal nerve and
superficial temporal vessels .
3. Anterior border : Separate anteromedial surface from lateral surface. Through which leaves
temporal, zygomatic, buccal and marginal mandibular branches of facial nerves. Parotid duct and
transverse facial artery.
4. Posterior border : Separate posteromedial surface from lateral surface. Through which leaves
posterior auricular nerve and vessels.

5. Medial border : Separate anteromedial surface from posteromedial surface. Related with pharynx.
6. Superficial or lateral surface : Is related to skin, superficial fascia contains platysma and parotid
fascia.
7. Anteromedial surface : Is related to ramus of mandible, masseter and medial pterygoid muscle.
8. Posteromedial surface : Is related to mastoid and styloid processes with muscles attached to them.

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 Structures inside the parotid gland
1. Facial nerve and its branches
2. Retromandibular vein
3. External carotid artery and its branches
Parotid duct
It is about 5cm long. It emerges from the anterior border of the gland and opens in the vestibule of
mouth opposite the crown of upper second molar tooth.
Nerve supply
Sensory : auriculotemporal nerve
Parasympathetic → from glossopharyngeal →tympanic plexus → lesser petrosal → otic ganglion →
auriculotemporal nerve .
Applied anatomy
Mumps : a viral infection that most often affects the parotid salivary glands

SUBMANDIBULAR GLAND

It is one of three salivary glands. It is a mixed type of gland, contain both serous and mucous.
Situation : Partly deep to the posterior half of mandible.
Shape : ‘J’ shaped.
Parts : It consists of two parts a large superficial part and small deep parts by mylohyoid muscle .

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 External features and its relations
Superficial part consists of
1. Superficial or inferior surface : It is related to the skin, superficial fascia containg platysma, deep
fascia and facial vein.
2. Lateral surface : It is related to submandibular fossa of mandible, facial artery and medial pterygoid
muscle.
3. Medial surface : It is related to mylohyoid muscle, hyoglossus muscle, styloglossus muscle,
mylohyoid nerve and vessels, lingual nerve with submandibular ganglion, glossopharyngeal nerve,
hypoglossal nerve, stylohyoid ligament and wall of pharyn

Deep part is related by

1. Medially : hyoglossus muscle
2. Laterally : mylohyoid muscle
3. Superiorly : lingual nerve with submandibular ganglion
4. Inferiorly : hypoglossal nerve

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Submandibularduct : it is about 5cm long. It origin from the deep part of the submandibular gland.
It opens into the oral cavity on the summit of a sublingual papilla at the side of the frenulum of the
tongue.
Arterial supply : submental and sublingual arteries.
Venous drainage : drains into common facial and lingual vein.
Nerve supply : Sensory by lingual nerve.
Parasympathetic by Facial nerve → chordatympani nerve → lingual nerve → submandibular
ganglion → ganglionic branch into submandibular gland.
Applied anatomy
Formation of calculi in the submandibular gland and its duct.

SUBLINGUL SALIVARY GLAND

It is the smallest salivary gland. It is mucous gland.

Location : between the mucous membrane of floor of the mouth and mylohyoid muscle.
Shape : almond
Sublingual duct are 15 in numbers, into the oral cavity on the submandibular duct.
Blood supply : sublingual and submental vessels.

Distinguishing features

Parotid gland Submandibular gland Sublingual gland

Location Near the ear Below the mandible Below the tongue
Development Ectodermal Endodermal Endodermal
Size Largest ( 25gm) Smaller ( 10 to 20gm) Smallest ( 3 to 4gm)
Shape Pyramidal ‘ J ‘ shaped Almond
Duct and it site of Parotid duct opens into Submandibular duct Series of duct opens
opening in oral cavity the vestibule of mouth opens into the floor of into the floor of the
opposite to the crown mouth on summit of oral cavity on the
of upper second molar sublingual papillae at sublingual fold
tooth the side of frenulum of
the tongue
Secretomotor nerve ▪ Through lesser ▪ Through •Through
supply petrosal nerve chordatympani nerve chordatympani nerve
▪ Preganglionic fibers ▪ Preganglionic fibers •Preganglionic fibers
arise from the inferior arise from the superior arise from the superior
salivatory nucleus salivatory nucleus salivatory nucleus
▪ Postganglionic from ▪ Postganglionic fibers •Postganglionic fibers
the otic ganglion arise from arise from
submandibular submandibular
ganglion ganglion

Nature of secretion Serous Both serous and Mucous

mucous

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 ESOPHAGUS

The oesophagus is a narrow muscular tube, forming the food passage between the pharynx and
stomach. It extend from the lower part of the neck to the upper part of the abdomen. It is about 25
cm long. It is divided in to three parts – cervival, thoracic and abdominal parts.
Constrictions : There are four sites of constrictions or narrowing in the oesophagus. It is measured
from the upper incisor teeth.
1. The first constriction at the distance of 15cm is produced by pharyngo-oesophageal junction.
2. The second constriction at a distance of 22.5cm is produced by the arch of aorta.
3. The third constrictionat a distance of 27.5cm is produced by left bronchus.
4. The fourth constriction at a distance of 40cm is at the oesophageal hiatus in the diaphragm.

Relations
1. Cervical part of the oesophagus
Anteriorly – trachea and recurrent laryngeal nerve.
Posteiorly - prevertebral fascia, longus colli muscles and vertebral column.
Laterally – lobes of thyroid gland and common carotid artery

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2. Thoracic part of the oesophagus
Anteriorly – Trachea, arch of aorta, right pulmonary artery, left principal bronchus, pericardium and
diaphragm
Posteriorly - Vertebral column, right posterior intercostals arteries,thoracic duct, azygos vein,
hemiazygos vein and thoracic aorta
Right - Right lung, pleura, vagus nerve and azygos vein
Left - Arch of aorta, left subclavian artery, lung and pleura,recurrent laryngeal nerve, descending
thoracic aorta and thoracic duct

3. Abdominal part
It is 1.25cm long. It enters the abdomen through the oesophageal opening of the diaphragm at T10
level.
 Arterial supply
Cervical part – inferior thyroid ateries.
Thoracic part – oesophageal branches of thoracic aorta and bronchial arteries.
Abdominal part- oesophageal branches of the left gastric artery and inferior phrenic artery
 Venous drainage
Cervical part drains into the inferior thyroid veins .
Thoracic part drains azygos and hemiazygos veins.
Abdominal part drains into hemiazygos and left gastric vein
 Lymphatic drainage
Cervical part drains into deep cervical part.
Thoracic part drains into the posterior mediastinal nodes.
Abdominal part drains into the left gastric nodes.
 Nerve supply
parasympathetic nerves – by the vagus.
sympathetic nerves - from the middle cervical ganglion and upper four thoracic spinal nerves.

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 Applied anatomy
1. Dysphagia means difficulty in swallowing- due to aneurysm of arch of aorta, enlarged lymph nodes
or carcinoma of oesophagus.
2. Carcinoma of oesophagus- the lower end of the oesophagus is prone to inflammation or ulceration
by regurgitation of acid from the stomach. It is the commonest site of oesophageal carcinoma.

STOMACH

The stomach is a muscular bag forming the widest and most distensible part of the digestive tube. It
connect lower end of esophagus to duodenum.
Location – occupying the epigastric, umbilical and left hypochondriac region
Shape :- Empty stomach - J-shaped.
Partly distended - pyriform shape.
Obese person - more horizontal.
Size :- 25cmlong
Capacity :- At birth - 30ml.
Puberty - 1L.
Adult - 1½ to 2L.
External features
The stomach has two orifices, two borders and 2 surfaces

Two orifices
1. Cardiac orifice : it is joined by lower end of esophagus. It lies behind the left 7th costal cartilage at
the level of T11 vertebrae. There is present physiological sphincter.
2. Pyloric orifice : It is joined by first part of duodenum. There is present a anatomical sphincter and
surface is indicated by a circular groove produced by the underlying pyloric sphincter and related by
prepyloric vein.
Two curvatures
1. Lesser curvature : it is concave and form the right border of the stomach. It provides attachment to
the lesser omentum. The most dependent part of the curvature is called angular notch.
2. Greater curvature : it is convex and form the left border of the stomach. It provides attachments to
the greater omentum, gastrosplenic ligament and gastrophrenic ligament. Its upper end present a
notch called cardiac notch.

Two surfaces
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1. Anterior surface : face forward and upwards.
2. Posterior surface : face downward and backwards.
Subdivisions
Stomach is divided into two parts – cardiac and pyloric parts by an imaginary line drawn from
angular notch to the greater curvature.
1. Cardiac part : the part above the line is called cardiac part. It is divided into- fundus and body
a. Fundus : Upper convex dome-shaped part situated above the horizontal line drawn from the
cardiac notch to the greater curvature.
b. Body : it lies between the fundus and pyloric antrum.
2. Pyloric parts : it is divided into two parts, pyloric antrum and pyloric canal.
a. Pyloric antrum : It is about 7.5cm long. It is separated from the pyloric canal by sulcus intermedius.
b. Pyloric canal : It is about 2.5 cm long and it is narrow and tubular.

Relations
1. Peritoneal relations
The stomach is lined by peritoneum on both its surfaces.
a. Lesser curvature – lesser omentum.
b. Greater curvature- greater omentum, gastrosplenic ligament and gasterophrenic ligament.

2. Visceral relations
a. Anterior surface - liver, diaphragm and anterior abdominal wall.
b. Posterior surface - structures forming stomach bed. They are diaphragm, left kidney, left suprarenal
gland, pancreas,transverse mesocolon, splenic flexure of colon, splenic artery and spleen.

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 Interior of stomach
It is lined by mucous membrane and form folds called gastric rugae. On the mucosal surface there
are numerous small depressions called gastric pit. The gastric glands are open into these pits.
Blood supply
Arterial supply

1. Left gastric artery- branch of celiac trunk.

2. Right gastric artery – branch of common hepatic artery.
3. Right gastero epiploic artery - a branch of gastero duodenal artery.
4. Left gasteroepiploic artery - branch of splenic artery.
5. Five to 7 short gastric artery – braches of splenic artery.
Venous drainage
The veins of stomach drains into the portal, superior mesenteric and splenic veins.
Lymphatic drainage : The stomach can be divided into four lymphatic territories.
First, divides the stomach into right 2/3rd and left 1/3rd by a line along its long axis. Then it divide
right 2/3rd into upper 2/3rd ( area 1) and lower 1/3rd ( area 4) and left 1/3rd into upper 1/3rd (area 3)
and lower 2/3rd (area 2).
Area 1→ is the largest area. Lymph from this area drained into left gastric nodes.
Area 2→ it includes pyloric antrum and pyloric canal along the greater curvature of the stomach.
The lymph from this area drains into the right gastro epiploic nodes and pyloric nodes.
Area 3 → it drains into the pancreaticosplenic nodes.

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 Area 4→ it includes the pyloric antrum and pyloric canal along the lesser curvature of stomach. The
lymph from this area is drained into hepatic and right gastric nodes.
The efferents from all these lymph node groups pass to coeliac nodes then into cysterna chyli.

Nerve supply
The sympathetic nerves are derived from thoracic six to ten segments of spinal cord.
The parasympathetic nerves are derived from-the vagus.
Applied anatomy
1. Peptic ulcer can occur in the site of pepsin and HCl, namely the stomach, first part of duodenum and
lower end of oesophagus.
2. Gastric carcinoma is common and occurs along the greater curvature.
Structure of stomach
1. Mucosa – is lined by simple columnar epithelium. Shallow gastric pits present. Lamina propria filled
with deep straight tubular glands with parietal and chief cells. Parietal cells also called oxyntic cells.
They secrete gastric acid and intrinsic factor. Chief cells also called zymogen cells. They secrete
pepsinogen.
2. Submucosa – loose connective tissue with blood vessels and nerves.
3. Muscularis externa – three layers- inner oblique, middle circular, outer longitudinal smooth muscle.
4. Serosa – membrane made of a simple squamous epithelium.

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 DUODENUM
It is the shortest, widest and most fixed part of the small intestine.
Extend : from the pylorus to the duodenojejunal flexure. It is ‘C’shaped and lies opposite to the L1
to L3 vertebrae.
Length -25cm long.
Parts
 First part - 5cm long.
 Second part- 7.5cm long.
 Third part – 10cm long.
 Fourth part – 2.5cm long.

Peritoneal realtions : it is retroperitoneal, except as its two ends.

First part
It extends from pylorus to superior duodenojejunal flexure.
Visceral relations : it consists of anterior, posterior, superior and inferior relations.
 Superiorly – epiploic foramen.
 Inferiorly - head and neck of pancreas.

Second part
It is extend from superior duodenal flexure to the inferior duodenal flexure.

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 Visceral relations : it consists of anterior, posterior, medial and lateral relations.
• Medially - head of the pancreas.
• Laterally – right colic flexure

Interior of the second part

1. The major duodenal papilla : is an elevation present posteromedially, 8 to 10cm distal to pylorus.
The hepatopancreatic ampulla opens at the summit of the papilla.
2. The minor duodenal papilla : is present 6 to 8 cm distal to the pylorus, and present the opening of
the accessory pancreatic duct.

Third part
Relations : it consists of superior, inferior, anterior and posterior relations.
Superiorly – head of the pancreas with uncinate process.
Inferiorly - coils of jejunum.

Fourth part
Relations : it consists of superior, inferior, right, left, anterior and posterior relations.
Superiorly - body of pancreas.
Left- left kidney and left ureter.
Right -upper part of root of mesentery.

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 Arterial supply
Superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery.
Venous drainage
The veins of the duodenum drainds into the splenic, superior mesenteric and poral vein.
Lymphatic drainage
The lymph vessels drains into pancreaticoduodenal lymph nodes.
Nerve supply
Sympathetic nerves- T9 and T10 spinal segments.
Parasympathetic – vagus.
Applied anatomy
Duodenal ulcer- the first part of the duodenum is the common site.

Structure of duodenum

1. Mucosa lined by simple columnar epithelium with microvilli and goblet cells. It contain folds called
villi. Lamina propria filled with intestinal glands called crypts of Lieberkuhn.
2. Submucosa contain loose connective tissue with blood vessels, lymphatic and nerve fibers. It contain
tubuloalveolar glands called Burnner’s glands.
3. Muscularis externa contain inner circular, outer longitudinal smooth muscle.
4. Serosa is lined by squamous cells.
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 JEJUNUM AND ILIUM

Features Jejunum Ileum

Location Occupies the upper and left part of Lower and right part of the
intestinal area. intestinal area
Walls Thicker and more vascular Thinner and less vascular
Lumen Wider and often empty Narrower and often loaded.
Mesentery 1.windows present 1.no windows
2.fat less abundant 2.fat more abundant
3.arterial arcades 1or 2 3.arterial arcades 3or 6 4.vasa
4.vasa recta longer recta shorter
Circular Larger and more closely set Smaller and sparse
mucosal fold
Villi Large, thick(leaf like) Shorter and thinner(finger like)
Peyer’s Absent Present
patches

Structure of jejunum

1. Mucosa is lined by simple columnar cells with microvilli and goblet cells. Lamina propria filled with
intestinal glands called crypts of Lieberkubn.
2. Submucosa is made up of loose areolar connective tissue with numerous blood vessels, lymphatics
and nerve fibers.

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3. Muscularis externa consists of inner circular and outer longitudinal smooth muscle layer.
4. Serosa is a peritoneal covering made of flat squamous cell

Structure of ileum
1. Mucosa is lined by simple columnar cells with microvilli and goblet cells. Lamina propria filled with
intestinal glands called crypts of Lieberkubn. Lamina propria shows aggregations of lymphoid
follicles called Peyer’s patches each containing 10 to 200 follicles.
2. Submucosa is made up of loose areolar connective tissue with numerous blood vessels, lymphatics
and nerve fibers.
3. Muscularis externa consists of inner circular and outer longitudinal smooth muscle layer.
4. Serosa is a peritoneal covering made of flat squamous cell.

LARGE INTESTINE
The large intestine extends from the ileocecal junction to the anus. It is about 1½ m in length. The
different parts of large intestine are-
 Caecum and vermiform appendix
 Ascending colon
 Transverse colon
 Descending colon

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  Sigmoid colon
 Rectum Anal canal

Features of large intestine

 Presence of taeniae coli which are three ribbon like bands of longitudinal muscle.
 The sacculations are the dilated parts in between the taenia coli.
 The appendices epiploicae are the fat filled bags of visceral peritoneum attached to the taeniae coli.

CAECUM

Caecum is a large blind sac forming the first part of the large intestine. It is situated in the right iliac
fossa. It communicate, Superiorly with ascending colon medially with ileum and posteromedially
with appendix
Dimension – 6cm long and 7.5cm broad.
Relations
Anteriorly – coils of intestine and anterior abdominal wall.
Posteriorly – muscles-right psoas and iliacus
Nerves – genitofemoral, femoral and lateral cutaneous nerve of thigh.
Vessels- testicular or ovarian and appendix
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 Arterial supply - ileocolic artery.
Venous drainage - into superior mesenteric vein.
Lymphatic drainage – it drains into → ileocolic nodes → superior mesentric group of preaortic
lymph nodes.
Nerve supply → sympathetic → T11 and L1 spinal nerves
Parasympathetic → vagus
Applied anatomy
Caecum is commonly involved in
1. Amoebiasis, causing amoebic dysentry
2. Intestinal tuberculosis
3. Carcinoma
VERMIFORM APPENDIX

This is a worm-like diverticulm arising from the posteromedial wall of caecum.

Length – 2 to 20cm.
Breadth – 5mm
Position – it is lies in right iliac fossa.
Appendicular orifice - It is situated in the posteromedial aspect of the caecum 2cm below the
ileocaecal orifice.
Parts
1. Base – attached to posteromedial wall of caecum.
2. Body – tubular part between base and tip.
3. Tip – it is directed in various directions. On the basis of direction of the tip it is classified into.

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 Positions Direction or Position of appendix
Paracolic or 11 O clock position The appendix is directed upwards and to the right. It is
about 2%.
Retrocaecal or 12 O clock position Directed upwards and lies behind the caecum or
ascending colon. This is the commonest position of
appendix. It is about 65%
Splenic or 2 O clock position. The appendix is directed upwards and to the left. It
points towards the spleen.
Appendix may be
1. anterior to ilium called preilial
2. Posterior to ilium called postilial
Promonteric or 3 O clock position. It is directed horizontally and to the left, pointing to the
sacral promontory. It is less than 1%.
Pelvic or 4 O clock position. It descend into the pelvis. It is about 30%
Midinguinal or 6 O clock position. It is directed vertically downward. Itlies behind the
caecum and may point towards the inguinal ligament.

Peritoneal relation – the appendix is suspended by small, triangular fold of peritoneum, called
mesoappendix.
Arterial supply- appendicular artery is a branch of the ileocolic artery.
Nerve supply
Sympathetic – derived from T9 and T10 segment of spinal cord.
Parasympathetic- derived from vagus.
Lymphatic drainage- drain to ileocolic node.
Applied anatomy
1. Inflammation of the appendix is known as appendicitis. The operation to removal of the appendix is
called appen-dicectomy.

Ascending colon
It isabout 12.5 cm long and extends from the caecum to theinferior surface of the right lobe of liver.
Right colic flexure(hepatic flexure of colon)
It is the junction of ascending colon and transverse colon.

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 Transverse colon
It is about 50cm long and extend across the abdomen from right colic flexure to left colic flexure.
Left colic flexure(splenic flexure)
It is the junction of the transverse colon and descending colon.
Descending colon
It is about 25cm long and extends from the left colic flexure to the sigmoid colon.
Sigmoid colon
It is about 37.5 cm long, and extends from the pelvic brim to the 3rd piece of sacrum, where it
become the rectum.
Arterial supply – right, middle and left colicarteries, ileocolic artery, sigmoid artery and superior
rectal artery.
Venous drainage – right, middle, left colic and iliocolic vein → superior mesenteric vein → portal
circulation .
Other vein → inferior mesenteric vein → portal circulation
Lymphatic drainage – paracolic nodes, intermediate colic nodes, epiploic nodes.
Nerve supply – sympathetic T11 to L1
Parasympathetic - vagus

Difference between Small intestine and Large intestine

Features Small intestine Large intestine

Appendix epiploicae Absent Present
Taeniae coli Absent Present
Sacculations Absent present
Distensibility Less More
Fixity Greater part is freely mobile Greater part is fixed
Villi Present Absent
Transverse mucosal folds Permanent Obliterated
Payer’s patches Present in ileum Absent
Common site for Intestinal worms, Typhoid & Entamoeba histolytica, Dysentry
Tuberculosis organisms & Carcinoma
Effect of infection & irritation Diarrhoea Dysentry

RECTUM

The rectum is the distal part of the large intestine. It is situated between the sigmoid colon and anal
canal in the pelvis. Three cardinal features of large intestine are absent.
Situation - posterior part of the lesser pelvis, in front of the lower 3 pieces of sacrum.
Extends – rectosigmoid junction to the anorectal junction.
Dimensions – 12cm long.
Upper part 4cm diameter.
Lower part dilated to form rectal ampulla.
Course – It runs first downward and backward and finally downwards and forwards.

Curvatures
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 1. Anteroposterior 2. three lateral curves

Relations
1. Peritoneal relations
 Upper 1/3rd of the rectum is covered with peritoneum in front and on sides.
 Middle i/3rd is covered only in front.
 Lower 1/3rd is devoid of peritoneum.

2. Visceral relations

Anterior relations Male Female

Upper 2/3rd rectovesical pouch with coils of rectouterine pouch with coils
small intestine and sigmoid colon. of small intestine and
sigmoid colon.
Lower 1/3rd urinary bldder, terminal part of vagina.
ureter, seminal vesicles, ductus
deferens and prostate.

Posterior relations :
sacrum, coccyx, piriformis, levatorani muscles, median and lateral sacral vessels, superior rectal
vessels and anococcygeal raphae.
Arterial supply : Superior rectal artery, middle rectal artery and median sacral artery.
Venous drainage : Superior rectal vein, middle rectal vein and median sacral vein.
Lymphatic drainage : inferior mesenteric nodes and internal iliac nodes.
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 Nerve supply : Sympathetic – L1 and L2 segments of spinal cord.
Parasympathetic – S1, S2 and S3.
Applied anatomy
1. Prolapse of rectum : pelvic diaphragm is weakened can cause prolapse of rectum.
2. Carcinoma of rectum – is common and situated in the rectosigmoid junction.

ANAL CANAL

Anal canal is the terminal part of the large intestine. It lies in between the right and left ischioanal
fossae.
Length – 3.8cm long.
Extent – anorectal junction to the anus.
Relations
Anteriorly
In both sex - perineal body.
In male – membraneous urethra and bulb of penis.
In females – lower end of vagina.

Posteriorly : Anococcygeal ligament and tip of coccyx.

Laterally : ischioanal fossae.
Interior of anal canal

It is divided into three parts

1. Upper mucous part

It is about 15mmlong and lined by mucous membrane. Mucous membrane shows-
 6 to 10 vertical folds; these folds are called the anal columns of Morgagni.
 Lower end of the anal columns are united to each other by a short transverse folds of mucous
membrane called anal valves.
 Above the each valve there is a depression in the mucosa called anal sinus.
 The anal valves together form a transverse line called pectinate line.
2. Middle part or pectin
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 It is about 15mm long and lined by mucous membrane.
 The mucosa has a bluish appearance because of a dense venous plexus, called pectin.
 The lower limit of pectin has a whitish appearance, is called white line of Hilton.
3. Lower cutaneous part
 It is about 8mm long and is lined by skin containing sweat and sebaceous glands.
Anal sphincters
1. Internal anal sphincter
It is involuntary in nature. It is formed by the thickened circular muscle coat. It surrounds the upper
three fourth.
2. External anal sphincter
It is voluntary in nature. It is made up of a striated muscle. It surrounds the whole length of the anal
canal.
Arterial supply
1. Above the pectinate line – superior rectal artery.
2. Below the pectinate line – ninferior rectal artery.
Venous drainage
Internal rectal venous plexus, external rectal venous plexus and anal veins.
Lymphatic drainage
1. Above the pectinate line drains into the internal iliac nodes.
2. Below the pectinate line drains into medial group of the superficial inguinal nodes.
Nerve supply
Above the pectinate line – sympathetic L1 and L2 spinal nerves.
Parasympathetic – S2 to S4 spinal nerves
Below the pectinate line by inferior rectal nerves.
Applied anatomy
1. Piles/ haemorrhoids-
a. Internal piles or true piles are saccular dilatations of the internal rectal venous plexus.
b. External piles or false piles occur below the pectinate line and are, therefore, very painful.
2. Fissure in ano – anal fissure is caused by the rupture one of the anal valve, usually by the passage of
dry hard stool in a constipated person.

LIVER

The liver is the largest gland in the body. It is reddish brown in colour.
It weighs is about 1600gm in males and 1300gm in females.
Location – right and left hypochondrium and epigastrium.
External features
It is wedge shaped. It has five surfaces and one border. Surfaces are - anterior, posterior, superior,
inferior and right.
Inferior border – it is sharp and it separates the anterior surface from inferior surface. It consists of
two notches - interlobar notch for the ligamentum teres and cyctic notch for the fundus of the gall
bladder.

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 Interlobar notch

Cystic notch

The liver is divided into right and left lobes by the attachment of :
 Falciform ligament anteriorly and superiorly.
 Fissure for ligamentum teres inferiorly.
 Fissure for ligamentum venosum posteriorly.
1. Right lobe
It is larger than the left lobe. It consist of caudate lobe and quadrate lobe.
Caudate lobe
It is situated on the posterior surface.
It is bounded -
 Right side by groove for inferior venacava
 Left side by fissure for ligamentum venosum.
 Inferiorly by porta hepatis.
Right lobe of liver is connected in to the caudate lobe by caudate process.
Left side of caudate lobe contain an elevation called papillary process.
Quadrate lobe
It is situated onthe inferior surface and is rectangular in shape.
It is bounded
 Anteriorly - inferior border.
 Posteriorly – porta hepatis.
 Right – fossa for gall bladder.
 Left - Fissure for ligamentum teres.
Porta hepatis
 It is a deep transverse fissure about 5cm long.
 It lies between caudate lobe above and quadrate lobe below.
 Structures passing through - the portal vein, hepatic artery, hepatic plexus of nerves, right and left
hepatic duct and lymphatics .
2. Left lobe
Left lobe of the liver is much smaller than the right lobe.
Relations
1. Peritoneal relations
Liver is covered by peritoneum, except triangular bare area on the posterior surface, groove for
inferior venacava, groove for ligamentum teres, groove for ligamentum venosum and fossa for gall
bladde.
Visceral relations
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 Anterior surface - xiphoid process, anterior abdominal wall and diaphragm.
Posterior surface-
1. Bare area is related o the diaphragm.
2. Groove for inferior venae cava.
3. Caudate lobe .
4. Fissure for ligamentum venosum.
5. Esophageal impression.
Superior surface - middle cardiac impression and on each side by dome of diaphragm.
Inferior surface

1. Gastric impression.
2. Fissure for ligamentum teres.
3. Lesser omentum,
4. The pylorus,
5. First part of duodenum.
6. Fossa for gall bladder .
7. Colic impression
8. Renal impression
9. Suprarenal impression.
Right surface - Upper 1/3rd is related to pleura
Middle 1/3rd is related to costodiaphragmatic recess
Lower 1/3rd is related to diaphragm
Blood supply
 20% blood supply through the hepatic artery
 80% trough the portal vein
Lymphatic drainage
Superficial lymphatics drains into caval, hepatic, paracardinal and celiac lymph nodes.
Deep lymphatics partly into inferior venaca and partly into hepatic nodes.
Nerve supply
Hepatic plexus which contains both sympathetic and parasympathetic or vagal fibers.
Applied anatomy
Inflammation of liver is referred to as hepatitis .
Under certain condition, example malnutrition, the liver tissue undergoes fibrosis and shrinks. This is
called cirrhosis of liver.
Structure of liver

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 It is covered by a connective tissue capsule, sends septa inside and divide the paranchyma into
lobule.
 Each lobule is hexagonal in shape.
 At the center of the lobule contains a central vein with branching and anastomosing plates of
hepatocytes radiating outward. The hepatocytes are seperated by sinusoids.
 At the periphery of the lobule portal triads are present which contain branches of hepatic artery and
portal vein withbile ductules.
 Hepatocytes are polyhedral in shape with rounded nuclei. Sinusoids lined by endothelial cells,
containing phagocytic macrophages called Kupffer cells.

GALL BLADDER

It is a fibrous sac which serves to collect and concentrate the bile.

Location : fossa on the visceral surface of right lobe of liver.
Shape : piriform
Parts : fundus, body and neck
Size : 9cm length, 3cm breadth and capacity - 30ml.

Parts and relations

Fundus - The anterior end is free, blind and expanded. It lies beyond the inferior margin of the liver
and covered by peritoneum.
Body – it lies between fundus and neck. It has two surfaces – upper and lower.
Upper surface is related to inferior surface of liver.
Lower surface is covered by peritoneum, transverse colon and first part of duodenum
Neck – is funnel shaped. Its wall present a dilatation called Hart mann’s pouch. It is related to
superior duodenal flexure.

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 Cystic duct : This duct is spirally curved and joined the the common hepatic duct to form the
common bile duct.

• Arterial supply - cystic artery.

• Venous drainage – cystic veins which drain into the portal vein.
• Nerve supply – cystic plexus of nerves, vagus nerve and right phrenic nerves.
• Applied anatomy
1. Cholecystitis – inflammation of gall bladder.
2. Gall stone

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 Questions

1. Name the parts of GIT with a neat labeled diagram. Briefly describe Liver, Stomach or
Pancreas.
2. Salivary glands ( parotid, submandibular and sublingual )
3. Esophagus
4. Stomach
5. Duodenum
6. Caecum
7. Appendix
8. Rectum
9. Anal canal
10. Liver
11. Pancrease
12. Gall bladder
13. Tongue
Difference between
14. Large intestine and small intestine
15. Jejunum and ileum
16. Parotid, submandibular and sublingual salivary glands
17. Constrictions of esophagus and ureter
List the
18. Parts of digestive system
19. Accessory glands of digestive system
20. Parts of large inestine

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