Anatomy 4.

Nov.9, 2011
Dr. Elevazo

Upper and Lower GIT-Gross

OUTLINE
1. UPPER GASTROINTESTINAL TRACT
I. Oral cavity
A. Lips
B.Vestibule
C. Mouth Proper
D. Temporomandibular Joint (TMJ)
E. Palate
F. Palate
G. Tongue
H. Salivary Glands
II. Pharynx
III. Esophagus
IV. Gastroesophageal joint
V. Stomach

2. LOWER GASTROINTESTINAL TRACT

I. Small Intestine
A. Duodenum
B. Jejenum
C. Ileum
II. Large Intestine
A. Cecum
B. Appendix
C. Acending Colon
D. Transverse Colon
E. Descending Colon
F. Sigmoid Colon
G. Rectum
H. Anal Canal
III. Blood Supply
IV. Venous Drainage
V. Lymphatic Drainage

UPPER GASTROINTESTINAL TRACT

I. ORAL CAVITY
Beginning or commencement of GIT
The GIT communicates to the outside through the oral cavity
From the oral fissures to the oropharyngeal isthmus (entrance to
the pharynx; formed on each side by the palatoglossal fold)
Consists of the lips, teeth, tongue, glands and muscles of
mastication

A.LIPS
2 fleshy folds that surround the oral orifice
Covered on the outside by skin and lined on the inside by mucous
membrane
Substance is made up by the orbicularis oris ms & muscles that
radiate from the lips into the face, and contains labial blood
vessels and nerves, CT and salivary glands
o philtrum Shallow vertical grove seen in the midline on the
outer surface of upper lip
o labial frenula Median folds of mucous membrane that
connect inner surface of the lips to the gums; cause problems in
the fitting of artificial dentures
Food is chewed by the teeth and saliva from salivary glands
facilitates the formation of bolus
o Deglutition (swallowing) is voluntarily initiated

Limited above and below by the reflection of the mucous

membrane from the lips and cheeks to the gums
Lateral wall: cheek made up by the buccinator muscle and is
lined with mucous membrane
o Duct of the parotid salivary gland opens on a small papilla into
the vestibule opposite the upper 2nd molar tooth
C.MOUTH PROPER
When mouth is open you see the following:
o Teeth
o Palate
o Tongue
Space posterior and medial to the upper and lower dental arches
in front of the oropharyngeal isthmus
Borders:
o Roof: hard palate (anterior) & soft palate (behind)
o Floor: anterior 2/3 of the tongue and the reflection of the
mucous membrane from the sides of the tongue to the gum of
the mandible (snell)
o Posterior/side: sublingual caruncle
o Apex: opening of whartons duct
o Posterior/lateral: sublingual fold
o Laterally and anteriorly bounded by the maxillary and
mandibular alveolar arches housing the teeth
Ducts of the submandibular and sublingual glands open onto
the floor of the mouth on either side of the frenulum
Muscles on the floor of the mouth
Table1. Muscles on the floor of the mouth
MUSCLE
NERVE SUPPLY
Infrahyoids depresses the mandible
Geniohyoid
C1 and C2 (ansa cervicalis)
mylohyoid, (R) & (L)
Inferior Alveolar nerve (branch of mandibular
division of trigeminal n.)
digastric, anterior belly
mylohyoid branch of mandibular division of
trigeminal n.
digastric, posterior belly
facial nerve
Suprahyoid elevates the mandible
Stylohyoid
facial nerve
Note: Action of muscle is always towards the origin of the muscle

Figure 1. Oral cavity, hard palate, etc

Figure2. TMJ and its parts

Divided into two by teeth and maxilla

B.VESTIBULE
A slit-like space that communicates with the exterior thru the oral
fissure when mouth is open and communicates with mouth
rd
proper behind 3 molar on each side when jaws are closed
o Lies between lips and cheeks (externally)
o Lies between gums and teeth (internally)

The vestibule and oral cavity proper are separated by teeth and
alveolar processes of mandible and maxilla

Group 4 | Baes, Ballero, Baluyot, Baas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 1 of 17

D. TEMPOROMANDIBULAR JOINT (TMJ)

Lower oral cavity
Modified hinge type of synovial joint
Divided into upper and lower cavities by the articular disc
o Composed of/articulation of the articular tubercle &
mandibular fossa of the temporal bone and the head or
condyloid process of the mandible
o Upper joint is for gliding movements (retraction and
protraction)
o Lower joint is for hinge movement (elevation, and depression)
Mandible
- U-shaped with flat ramus (R & L)
- Transmits vessels (arteries, veins and nerves)
- Not fused in children <2 y/o
- Becomes fused at midline in children >2 y/o
- Mandibular foramen (inner) found in medial aspect which
contains inferior alveolar vessels and nerve to exit the
mental foramen as mental vessels and nerves
(anterior/outer)
o Covered with fibrocartilage
o Nerve supply: auricular temporal and masseteric branches of
mandibular nerve
o Movements that occur at the tmj:
Retraction and protrusion (gliding joint):superior
compartment
Elevation and depression (hinge joint): inferior compartment
LIGAMENTS OF THE TEMPOROMANDIBULAR JOINT
o Lateral temporomandibular ligament
Thickening of fibrous capsule
Prevents TMJ from extending posteriorly
(normal: expect an anterior movement)
o Sphenomandibular ligament
Medial side of TMJ; primary passive support of tonus
Provides primary support to TMJ
Prevent jaws from falling down
o Stylomandibular ligament
Behind and medial to TMJ; does not strengthen joint
Thickening of fibrous capsule of parotid gland

E.PALATE
Forms roof of the mouth; floor of nasal cavity
Separates oral cavity from nasal cavity and nasopharynx
Divided into two:
o Hard Palate
o Soft Palate
HARD PALATE
o Anterior palate; continuous behind with the soft palate
Formed by palatine process of maxillae and horizontal
plates of palatine bones; bounded by alveolar arches
o Covered with mucous membrane
o Space filled with the tongue when it is at rest
o Foramina: Areas where dentist injects anesthesia
o Incisive fossa: Slight depression post. To the central incisor
teeth
o Incisive canals and foramina that open into the fossa contain
nasopalatine nerves
o 2 openings found in the postero-lateral end:
Greater palatine foramen (pl, foramina)
- Medial to the 3rd molar tooth; pierces the lateral border of
the bony palate from which greater palatine vessels and
nerve emerge
Lesser palatine foramen (pl, foramina)
- Transmit lesser palatine nerves and vessels
- Posterior to the greater palatine foramen, pierces the
pyramidal process of the palatine bone
o Undersurface is covered by: mucoperiosteum, and possess
median ridge
Has palatine raphe and transverse palatine folds
o Mucous membrane covered by stratified squamous epithelium
(at posterior, possess many mucous glands)

Lateral temporomandibular ligament is intrinsic ligament, while the latter

two, sphenomandibular and stylomandibular, are extrinsic ligaments

Muscles of Mastication
o All are innervated by mandibular branch of CNV and all crosses
the TMJ
Temporalis Elevates (anterior fibers) & retracts (posterior
fibers) mandible
Masseter Elevates mandible
Medial pterygoid Elevates mandible
Lateral pterygoid Depresses and protracts mandible
o Buccinator muscle is an accessory muscle of mastication
o Muscles that protract the mandible:
Pterygoids (internal and external)
Masseter
Temporalis (anterior fibers)
o Muscles that retract the mandible:
Temporalis (posterior fibers)
CLINICAL CORRELATON
Excessive contraction of lateral pterygoid muscles can
dislocate the jaw anteriorly (most of the time, because head
is in front of anterior tubercle) due to the intrinsic ligament
and glenoid tubercle
In surgical correction, facial nerve and auriculotemproal
branch of mandibular nerve are prone to damage

Figure3. Palate and its parts

SOFT PALATE
o A mobile fold attached at posterior of hard palate
o Closes the nasopharynx
o Covered on its upper and lower surfaces by mucous
membrane
o Contains aponeurosis, muscle fibers, lymphoid tissue, glands,
vessels and nerves
o Laterally continuous with the wall of the pharynx
Joined to the tongue by the palatoglossal arch and to the
pharynx by the palatopharyngeal arch
Palatine tonsils masses of lymphoid tissue, one on each
side of the oropharynx; each lies in a tonsillar sinus (fossa),
bounded by the palatoglossal and palatopharyngeal arches
and the tongue
Uvula conical projection at its free posterior border in the
midline

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 2 of 17

Table 2. Muscles of Soft Palate

Muscle
Tensor veli palatini

Levator veli palatini

Palatoglossus

Palatopharyngeus

Musculus uvulae

Main Action
Tenses soft palate
and opens the
pharyngotympanic
tube during
swallowing and
yawning
Elevates soft palate
during swallowing
and yawning
Elevates posterior
part of tongue and
draws soft palate
onto tongue
Tenses soft palate
and pulls walls of
pharynx during
swallowing
Shortens uvula and
pulls it superiorly

Innervation
Medial pterygoid nerve
(a branch of mandibular
nerve CN V3)

o Root canal transmits nerves and vessels to and from the pulp
cavity through the apical foramen
o Apical foramen transmits blood vessels, lymph and nerves. It
is the opening at each root
o Pulp cavity internal tooth portion
Odontoblast, a single layer of cells, surround the dentin layer
Surrounded by dentin (the most sensitive part of the teeth)
Contains blood vessels, lymph and nerves
Protected by enamel at area of crown
Protected by cementum at area of root
o Alveolar periosteum - anchors the teeth

Pharyngeal branch of
vagus nerve (CN X) via
pharyngeal plexus

F. TEETH
Functions:
o incise, reduce, mix with saliva, and grind during mastication
o support and protect the oral cavity articulation(speech)
There are two sets of teeth
o Deciduous teeth (temporary) / milk teeth
o Permanent teeth
DECIDOUS TEETH OR MILK TEETH
o Begin to erupt about 6 months after birth
o Completely erupted by the end of second year
Central incisors (6-8 mos)
Lateral incisors (8-10 mos)
First molars (1 yr)
Canines (18 mos)
Second molars (2 yrs)
o There are 20 in number (5 on each side of the jaw)
4 incisors
2 canines
4 molars in each jaw
Teeth on the lower jaw usually appear before those on upper jaw
Lower central incisor first to erupt (temporary set) around 6 months
PERMANENT TEETH

o Begin to erupt at 6th year

o LAST tooth to erupt is the 3rd molar (17-30th yr)
o There are 32 in number
First molars (upper-6 yr)
Central incisor (7 yr)
Lateral incisor (8 yr)
First premolars (9 yr)
Second premolars (12 yr)
Third molars wisdom teeth (17-30 yr)
o Completed by age of 12yo

Teeth on the lower jaw usually appear before those on upper jaw
Lower first molar first to erupt (permanent set)
It is connected to the bone via special type of fibrous joint called
GOMPHOSIS or Dento-alveolar syndesmosis
PARTS OF A TOOTH

o Crown part that protects beyond the gums (it is above the
gum/gingival)
o Neck constricted portion between crown and root
o Root embedded in maxilla and mandible (alveolar
periosteum); attached to alveolar process of mandible or
maxilla

Figure 4. Parts of the teeth

Note:
- The only sensation transmitted in the teeth is pain
- Incisors have sharp a sharp edge for biting; Molars and Premolars are
for grinding; Canines have rounded edge for tearing and for cosmetic
purposes (they maintain the shape of the face of an individual)
- Tongue (medially) and cheeks (laterally) help keep the food in between
teeth

G. TONGUE
Mobile mass of voluntary striated muscles covered with mucous
membrane
Anterior two thirds lies at mouth
Posterior lies at pharynx
Muscles; attach it to styloid process and soft palate above, and to
mandible and hyoid bone below
Also used in phonation
Arises from floor of mouth
PARTS OF THE TONGUE
Roof inferior, relatively fixed part attached to the hyoid and
mandible and in proximity to the geniohyoid and mylohyoid
muscles; it is the pharyngeal portion of the tongue
Body remaining part: anterior 2/3
Apex pointed anterior part of the body
Dorsum posterosuperior surface of the tongue, which includes a
v-shaped groove(terminal sulcus), the apex of which points
posterior to the foramen cecum
Upper surface of the tongue
o Fibrous septum divides tongue in left and right halves
o Sulcus terminalis divides mucous membrane of the upper
surface of tongue into posterior thirds (pharyngeal part) and
anterior 2/3 (oral part); apex directed posteriorly
o Foramen Cecum a small pit that marks the apex of the sulcus
projecting backward; remnant of thyroglossal duct (where fetal
thyroid starts to develop)
Anterior 2/3 of the tongue (upper surface)
o Papillae increase the area of contact between the surface of
the tongue and the contents of the oral cavity; for proper
handling of food

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 3 of 17

o Filiform papillae with tapered ends, most abundant, forms

small conical projections and are whitish in color due to
thickness of cornified epithelium (keratinized, no taste buds)
o Fungiform papillae less numerous, scattered on sides and
apex of tongue, mushroom-shaped, reddish tinge due to
vascular connective tissue core; contain taste buds
o Circumvallate or vallate papillae 8-12 in number, situated in
a row in front sulcus terminalis; surrounded by circular furrow,
where taste buds lie; surrounded by deep moat-like trenches,
into which the ducts of serous lingual glands of von Ebner
open; epithelium rich in tastebuds
o Foliate papillae found at the posterior end of the margin of
the anterior 2/3 of tongue, underdeveloped in humans; welldeveloped in rodents

Figure5. Taste buds

Posterior third of the tongue

o Devoid of papillae BUT contains lingual tonsil (small nodules of
lymphoid tissue) which makes the mucosa covering the
pharyngeal surface of the tongue irregular in contour
o Vallecula depression of tongue where foreign bodies such as
fish bones may lodge
Inferior portion of the tongue (when tongue is up and back)
o Lingual Frenulum a fold of mucous membrane that connects
undersurface of tongue to floor of mouth
o Plica fimbriata fringe fold formed by mucous membrane,
lateral to deep lingual vein.
o Deep lingual veins found in between the fimbriated fold and
frenulum, seen thru mucous membrane; responsible for rapid
absorption of drugs taken sublingually e.g nitroglycerine for MI.
o Sublingual caruncle papilla on each side of the lingual
frenulum marking the opening of the submandibular gland or
Whartons duct
o Sublingual fold (or plica sublingularis) low fold mucous
membrane beneath the tongue which marks the site of the
sublingual gland

CLINICAL CORRELATON
If there is lesion in the peripheral nerve, when you stick out your
tongue you expect it to go to the direction of the lesion
Table3. Muscles of the Tongue
MUSCLE

ACTION
Extrinsic
acting bilaterally: depress central
Genioglossus
part of tongue, acting unilaterally:
fan-shaped
deviate tongue toward contralateral
side
depresses tongue, pulling its sides
Hyoglossus thin,
inferiorly, aids in retrusion
quadrilateral muscle
(retraction)
retrudes the tongue and curls its
Styloglossus small
sides, acting with genioglossus
short muscle
creates a trough during swallowing
Palatoglossus
elevates tongue, pulls down soft
primarily pharyngeal
palate
Intrinsic muscles not attached to bone
Superior longitudinal
muscle thin layer
curls apex of tongue, makes dorsum
deep to mucous
of tongue concave longitudinally
membrane on dorsum
of tongue
curls apex of tongue inferiorly,
Inferior longitudinal
makes dorsum of tongue convex
muscle narrow bands
superior and inferior makes
close to inferior
tongue short and thick in retracting
surface
the protruded tongue
Transverse muscle
narrows and increase the height of
lie deep to superior
tongue
longitudinal muscle
flattens and broadens the tongue
Vertical muscle runs
inferolaterally from
transverse and vertical makes
dorsum of tongue
tongue long and narrow

NERVE SUPPLY

Hypoglossal
nerve

Pharyngeal
plexus

Hypoglossal
nerve

Figure 7. Muscles of the Tongue

Note:
- ALL muscles of tongue are supplied by hypoglossal nerve EXCEPT the
palatoglossus ms, which is supplied by the pharyngeal plexus
- The pharyngeal plexus is from vagus n., glossopharyngeal n., and
sympathetic n.
Table 4. Taste Buds
GENERAL SENSATION

Anterior 2/3

Posterior 1/3

TASTE
Chorda tympani (facial
Lingual n. (mandibular
n.) EXCEPT vallate
br. of trigeminal n)
papillae
Glossopharyngeal n.
posteromedial aspect partly innervated by Vagus
nerve

Taste buds of the circumvallate or vallate papillae receive

innervation from nerves that supply posterior 1/3 of the tongue
(CN IX)
Figure 6. Floor of Mouth and Vestibule

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 4 of 17

Arterial Supply of Tongue

o Dorsal lingual arteries posterior part (root) of the tongue
& send tonsillar branch to the palatine tonsil
o Deep lingual artery anterior part of the tongue;
communicates with the dorsal a. Near the apex of the tongue
o Sublingual artery sublingual gland & floor of the mouth
Venous Drainage of Tongue
o Dorsal lingual veins accompany the lingual a.
o Deep lingual veins begin at the apex of the tongue & run
posteriorly beside the lingual frenulum to join the sublingual
vein
All lingual veins terminate, directly or indirectly, in the IJV
(continuation of sigmoid sinus)
Lymphatic Drainage
AT the posterior 1/3 and the medial anterior 2/3 of the
tongue, the lymphatic vessels criss cross to the other
side
o Superior deep cervical lymph nodes posterior 1/3
o Inferior deep cervical lymph nodes medial anterior 2/3
o Submandibular lymph nodes lateral anterior 2/3
o Submental lymph nodes apex of the tongue & frenulum
o ALL eventually drain into the deep cervical lymph node
Clinical Correlation
Carcinomatosis involving the poeterior 1/3 of the tongue,
metastasis to tboth side is very early because of the criss
crossing of the lymphatic vessels.
H. SALIVARY GLANDS
Secrete saliva, which keeps mucous membrane of mouth moist,
lubricates food during masctication, begins digestion of starches,
serves as an intrinsic mouthwash, & plays role in prevention of
tooth decay & in the ability to taste
Named according to where it is found
o Mucosa of cheek- Buccal glands
o Mucosa of Lips- Libel gland
Table 5. Salivary Glands
SALIVARY GLAND

LOCATION

ARTERIAL SUPPLY;
VENOUS DRAINAGE

Parotid glands
- largest of the major
salivary glands
- duct is called
Stensens duct

gap between ramus

of mandible & styloid
& mastoid processes
of temporal bone

external carotid a. &

superficial temporal
a.; retromandibular
veins.

along body of
mandible
floor of the mouth
between mandible &
genioglossus ms.

submental a.;
submental v.

Submandibular gland
Sublingual gland
- smallest & most
deeply situated

sublingual a. &
submental a.

Figures 8.2 Salivary glands

o
o
o
o
o

II. PHARYNX
From base of skull to lower cricoid cartilage (C6 level)
Behind the nasal cavities, the mouth and the larynx
A musculomembranous tube
Funnel-shaped; common passage of food and air
Upper, wide-end lie under the skull
Lower, narrow end becomes continuous with esophagus opposite
C6.
Has musculomembranous walls, which is deficient anteriorly
(replaced by posterior nasal apertures, oropharyngeal isthmus
and inlet to larynx)
Pharynx connects with 7 cavities anteriorly
(R) & (L) nasal cavities (choanae/nares)
(R) & (L) eustachian tube (lateral)
Oral cavity (front)
Laryngeal cavity
Esophagus (below)

A.MUCOUS MEMBRANE
Continuous with the nasal cavity, mouth and the larynx
Continuous with the tympanic cavity thru the auditory tube
Upper part, pseudostratified ciliated columnar epithelium
Lower part, stratified squamous epithelium
Transitional zone where the two areas come together
B. FIBROUS LAYER
Pharyngobasilar fascia strong internal fascial lining of the
constrictor muscles
o Between the mucous membrane and the muscle layer
o Thicker above, strongly connected to the base of the skull
o Becomes continuous with the submucous coat of the
esophagus
Buccopharyngeal fascia thin external fascial lining of the
pharyngeal muscles
Pharyngeal aponeurosis: covers the the pharyngeal muscle which
if extends to esophagus, will be the muscularis mucosa of
esophagus

Figure 8.1 Salivary Glands

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 5 of 17

C. MUSCULAR LAYER
Table 6. Pharyngeal Muscles
MUSCLE
External circular
Super constrictor

Middle constrictor
Inferior constrictor
Cricopharyngeus

Internal longitudinal
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus

ACTION
aids soft palate in closing off
nasal pharynx, propels bolus
downward
propels bolus downward

NERVE SUPPLY
Pharyngeal
plexus

sphincter at lower end of

pharynx; prevents the
swallowing of air
elevates larynx during
swallowing
elevates pharynx
elevates wall of pharynx, pulls
palatopharyngeal arch medially

CN IX
Pharyngeal
plexus

ALL pharyngeal ms are innervated by pharyngeal plexus EXCEPT

stylopharyngeus, which is innervated by the glossopharyngeal n
Muscularis externa is always made up of inner circular and outer
longitudinal muscle layer but the pharynx is made up of inner
longitudinal and outer circular muscle layer
The posterior fiber of the superior constrictor muscles works handin-hand with the soft palate in closing the nasopharynx when
swallowing
D.PARTS OF PHARYNX
NASOPHARYNX or EPIPHARYNX
o Posterior to nasal cavity/chonae
o Purely respiratory in function; only allows passage of air
o Mucosa lined with respiratory epitheleum
o Anterior: choanae/posterior nares
o Posterior: base of skull (c1/atlas)
o Roof : supported by the sphenoid and occipital bone; where
pharyngeal tonsils can be seen
o Floor: upper surface of soft palate; opening is called pharyngeal
isthmus
o Lateral wall : contains opening of the Eustachian/
pharyngotympanic tube and mucosal elevations and folds
covering the tube and the adjacent muscles
Salpingopharyngeal fold desends from the tubal elevation
and overlies salpingopharyngeus muscle
Torus levatorius broad elevation emerging from under the
tube; overlies levator veli palitini muscle
Tubal tonsil (important structure of the nasopharynx from
Dr. Elevazo) - lymphoid tissue around opening of the tube;
should atrophy during puberty
Sensory nerve supply (nasopharynx): maxillary nerve (V2)

o Waldeyers ring = pharyngeal + palatine + lingual tonsils + tubal

tonsils
Lingual tonsils anteroinferior part of ring
Palatine tonsils (important structure of the oropharynx
from Dr. Elevazo) most frequently infected; together with
tubal tonsils are found on the lateral wall of the oropharynx
Pharyngeal tonsils posterior part of ring; hypertrophic in
children but atrophies in puberty
o Valecula depression or space between posterior 1/3 of
tongue and epiglottis where fish bone may lodge
o Median glossoepiglottic fold: fold in midline of base of the
tongue
o Oropharyngeal isthmus: interval between palatoglossal arches
Sensory nerve supply (orophraynx): glossopharyngeal nerve
LARYNGOPHARYNX OR HYPOPHARYNX
o Behind laryngeal inlet
o Posterior to the larynx, from superior border of epiglottis and
the pharyngoepiglottic folds to the inferior border of the
cricoid cartilage, where it narrows and becomes continuous
with the esophagus
o Cricopharyngeus muscle acts as a sphincter that prevents
the air to pass in esophagus
Posteriorly, related to bodies of C4 thru C6 vertebrae
Behind the laryngeal inlet or aditus (formed by epiglottis:
aryepiglottoc fold and interarytenoid notch)
o Piriform fossa groove in the mucous membrane on each side
of laryngeal inlet, behind the cuneiform and corniculate
tubercles and between cricoid and thyroid cartilage lamina
Where foreign bodies such as fish bone may lodge when fish bone
is not found at the valecula
Sensory nerve supply (laryngopharynx): internal laryngeal branch
of the vagus nerve
E.ARTERIAL SUPPLY
Upper part
o Ascending pharyngeal a.
o Ascending palatine and tonsillar branches of facial artery
o Maxillary artery
o Lingual artery
Lower part (including cricopharyngeus ms)
o Superior thyroid artery

Clinical Correlation
Pharyngeal tonsils, when enlarged, are called adenoids which
can block the Eustachian tube opening
Tubal tonsil may cause otitis media when it blocks the opening
of the Eustachian tube

OROPHARYNX
o Digestive function; stratified squamous epithelium
o Behind the soft palate to hyoid between laryngeal inlet and soft
palate
Superiorly: bounded by soft palate
Inferiorly: base of the tongue
Laterally: palatoglossal and palatopharyngeal arches
Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Figure 9. Blood Supply of Pharynx

Page 6 of 17

Anteriorly : related to posterior of LEFT lobe of liver

Posteriorly : related to LEFT crux of diaphragm
Divided into 3 parts: cervical, thoracic and abdominal
Enters the abdomen via right crux of diaphragm

A. THREE PORTIONS OF ESOPHAGUS

Cervical
o Anterior: trachea
o Posterior: cervical vertebrae
o Lateral: thyroid gland, carotid sheath
o In groove between trachea and esophagus: recurrent laryngeal
nerves
Thoracic (thorax)

Figure 10. Parts of Pharynx

E. VENOUS DRAINAGE
External palatine vein (paratonsillar vein)
Retromandibular v. union of superficial temporal and maxillary
veins
o Drain into pharyngeal venous plexus into internal jugular v.
E. LYMPHATIC DRAINAGE
Directly into superior cervical group of nodes (runs along IJV)
Indirectly into retropharyngeal or paratracheal nodes then into
deep cervical nodes
All eventually drain into deep cervical lymph nodes

o Anterior: trachea, (L) recurrent laryngeal nerve, (L) principal

bronchus (T5) & pericardium Left atrium(below thoracic
bifurcation)
o Posterior: bodies of upper thoracic vertebrae, thoracic duct,
azygos veins,hemiazygous vein, (R) posterior intercostals
arteries, descending thoracic aorta
o Laterally on Right: mediastinal pleura ,terminal branch of
azygos vein (T4) and parietal pleaura
o Left: above tracheal bifurcation: ascending portion of left
subclavian artery, aortic arch (T4), thoracic duct, parietal pleura
o Below tracheal bifurcation: descending aorta
o T8: descending aorta lies beneath esophagus
Abdominal
o Anterior: inferior surface of (L) lobe of liver
o Posterior: (L) crus of diaphragm
B. COURSE OF ESOPHAGUS
In the neck, lies in the midline
In the thorax, it is to the left, passing thru superior then posterior
mediastinum
At the level of sternal angle (T4-T5), aorta pushes esophagus back
to midline
At t10, passes on opening of right crux of the diaphragm, then
after course, joins stomach at right side 7th left costal
cartilage and T11
Note:
- (L) vagus n. Anterior to esophagus, (R) vagus nerve Posterior to
esophagus [L.A.R.P.]
- Peristalsis wave-like contraction of the muscular coat, propels
the food onward
- Phrenicoesophageal ligament: attach esophagus to margins of
esophageal hiatus in diaphragm
C. FOUR CONSTRICTION AREAS

Figure 11. Venous and lymph drainage of pharynx

III. ESOPHAGUS
Extends From Lower border of cricoids cartilage (C6) to are where
it inserts at cardia of stomach at level of (T11)
Goes down and enters the super and inferior mediastinum of
thorax
Enters esophageal hiatus(T10) to enter cardia of stomach (T11)
Conduct food from the pharynx into the stomach
A muscular collapsible tube 10 in. (25 cm) long
Joins pharynx to stomach
Greater part lies within the thorax
Covered anteriorly and laterally by peritoneum

Where foreign bodies may lodge

Offer resistance in passageway
1. C6 : caused by cricopharyngeus (superior esophageal sphincter)
/ cricopharyngeal constriction
-at junction between pharynx and esophagus
-When it contracts- prevents entry of air when swallowing
2. T4 : arch of the aorta / bronchoaortic constriction
3. T5 : level of (L) main bronchus / bronchoaortic constriction
(2 and 3)4. T10 : esophageal hiatus of diaphragm / diaphragmatic
constriction /inferior esophageal sphincter
Clinical Correlation
If you ingest acid, these constriction areas will obtain the most
damage
During endoscopy, these areas are most common sites of injury

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 7 of 17

G. PORTAL-SYSTEMIC OR PORTO-CAVAL ANASTOMOSES

Communication between the portal and systemic systems;
become important when direct route (hepatic veins to IVC)
becomes blocked
Table 7. Portal System

PORTAL SYSTEM
SYSTEMIC SYSTEM
esophageal branches of (L) gastric
esophageal branches of
vein
azygos veins
when abnormally dilated: esophageal varices
superior rectal veins continuing as
inferior and middle rectal
the inferior mesenteric veins
veins
when abnormally dilated: hemorrhoids

paraumbilical veins connected to

the (L) branch of the portal vein

superficial epigastric veins

when dilated: caput medusae

Figure12. Location of Esophagus

D. MUSCULAR LAYER OF ESOPHAGUS

Upper 3rd: Skeletal
Middle 3rd: Mixed
Lower 3rd:Smooth
o Inner circular
o Outer longitudinal
Note:
- Trachea (trachealis) ms and anterior esophagus forms the
common party wall (above and below isthmus of thyroid)
- In children, trachea is pencil size; esophagus is prone to damage
during a tracheostomy

twigs of colic veins (veins of

descending & ascending colon,
duodenum & pancreas)

retroperitoneal veins (renal,

lumbar & phrenic veins)

E. BLOOD SUPPLY
Cervical part: inferior thyroid a. (r & l thyrocervical, sca)- branches
of thyrocervical trunk from subclavian artery
Thoracic part : esophageal arteries (branches of descending
aorta) & branches of bronchial arteries (2 on left 1 on right), right
posterior intercostal arteries
Abdominal part :comes mainly from left gastric a. (br. Of celiac a.)
And recurrent branch from left inferior phrenic a.
+++may also come from short gastric artery from splenic artery
that supplies fundus of stomach

F. VENOUS DRAINAGE
Drain into the left gastric vein, tributary into the left gastric nodes
o Cervical part: (R) & (L) inferior thyroid veins to (R) & (L)
brachiocephalic veins
o Thoracic part: azygos and hemiazygos v.
o Abdominal part:primarily to portal venous system via left
gastric vein (portocaval anastomoses) on lower 1/3 of
esophagus
o +++submucosal venous plexus penetrate entire wall of
esophagus forming peri-esophageal venous plexuses
Clinical Correlation
Liver cirrhosis progressive destruction of hepatocytes, which are
replaced by fibrous tissue; fibrous tissue surrounds intrahepatic
vessels, impeding the circulation of blood; there is then retrograde
flow of blood; submucosal plexuses becomes dilated and tortuous
causing varices which are prone to hemorrhage-> bleeding
esophageal plexuses.
++obstruction of portal vein because of alcoholic cirrhosis of liver
will cause retrograde flow of blood back from portal vein, left
gastric vein, peri-esophageal sinuses and back to submucosal venous
plexuses producing esophageal varices> liver cirrhosis

Figure 13. Portal-system

H. LYMPH DRAINAGE

Follows arteries into the left gastric nodes

Starts below the tracheal bifurcation
Cervical: inferior deep cervical nodes in lower portion of IJV
Thoracic:
o Above carina:
o Anterior: paratracheal and superior and inferior
tracheobronchial nodes
o Posterior: posterior mediastinal & intercostal nodes,
collectively called posterior parietal nodes
o Below carina: superior phrenic nodes
Abdominal: left epigastric and celiac nodes draining to cisterna
chyli then to thoracic duct

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 8 of 17

Summary of lymphatic drainage( Dr. Elevazo):

Cervical portion: nodes on lower portion of Internal jugular vein
and find its way on thoracic duct (left) and Right lymphatic duct
(right)
Abdominal: lymphatic channels emptying on left gastric nodes>
efferent on left gastric nodes empty on ciliac nodes> efferent on
ciliac nodes empty on intestinal trunk( major tributary of cysterna
chylli/thoracic duct together with aorta at level of T12/ L1)
Thoracic: Landmark is tracheal bifurcation:
o Above: ant wall: tracheobronchial and paratracheal nodes
o Posterior wall: both above and below: post mediastinal
bifurcation
o Below tracheal bifurcation: phrenic nodes
o Right: right lymphatic duct
o Left: thoracic duct
I. NERVE SUPPLY

Anterior and posterior epigastric nerves (vagi)

Sympathetic branches of the thoracic part of the sympathetic
trunk(S4-S6)
Postganglionic sympathetic: follow branchings of blood vessels of
cervical, thoracic and abdominal portions
Parasympathetic : vagus nerve
o Cervical (R) & (L) vagus nerves and (R) & (L) recurrent
laryngeal nerves
o Thoracic - Above tracheal bifurcation: (R) & (L) vagus nerves
and (L) recurrent laryngeal nerve
- (R) recurrent hooks around the subclavian artery and does
not get in contact with the esophagus
- Below tracheal bifurcation: esophageal plexus: 1-2 cm above
esophageal hiatus unite to form: (L vagus) anterior & (R
vagus) posterior vagal trunks (LARP) + sympathetic nerves
Abdominal anterior and posterior vagal trunks

IV. GASTROESOPHAGEAL JUNCTION

Also known as cardia, Z-line or esophagogastric junction lies in
th
left of T11 and left 7 costal cartilage
Transition from stratified squamous to simple columnar epith.at
area of cardia of stomach
Has specialized smooth mucles fibers at esophagogastric
vestibule which is a thickening of lower portion of esophagus to
cardia, about 2cm above esophageal hiatus and with thickened
smooth muscle
Contain inferior or lower esophageal sphincter (LES)
o Angulation
o Rosette arrangement
o Sphincteric effect of contraction of diaphragm
o Prevents regurgitation of food from stomach to esophagus
Netter: 1-2 cm above esophageal hiatus at area of cardia>
muscle thickening called esophagogastric vestibule which
contains specialized smooth muscle fiber called inferior
esophageal sphincter
Moore: contraction of diaphragm prevents regurgitation of
food from stomach into esophagus

A. GASTROESOPHAGEAL SPHINCTER

NOT an anatomic sphincter BUT a physiologic sphincter because

of circular layer of smooth muscle
Its tonic contraction prevents regurgitation of stomach contents
into esophagus
Closure of this is under vagal control

o Gastrin augment closure and dilatation

o Secretin, cholecystokinin, and glucagons reduce response
Note:
- No anatomical sphincter exists at lower end of esophagus
Clinical Correlation: if this area does not contract well, the patient
will experience reflux esophagitis
Other factors that prevent regurgitation of food:
1. Angle of junction between esophagus and stomach
2. Rosette arrangement
3. Sphincteric effect of diaphragm

V. STOMACH
Expanded part of the digestive tract between the esophagus and
small intestine.
Acts as a food blender and reservoir
Its main function is Enzymatic Digestion
Can hold 2-3 liters of food
Gastric juice converts food into a semi-liquid mixture, chime
Position and Shape
o Size shape and position can vary markedly in persons of
different body types.
o Found in left hypochondrium and epigastric area and may
extend to area of umbilicus
o In supne position, it commonly lies in the upper right and left
quadrants
o J shaped, and vertical (in tall,thin person)
o Fixed at both ends, but mobile in between

Figure14. Parts of the Stomach

A. Parts of the Stomach

Cardia part that surrounds the cardial or cardiac orifice, the
superior opening or inlet of the stomach
o Receives distal end of esophagus
th
o Posterior to 6 (L) costal cartilage, 2.4cm from the median
plane at the level of T11 vertebra
Fundus of the stomach
o Dome-shaped; usually full of gas
o Related to the left dome of the diaphragm
o The Cardial Notch is between the esophagus and the fundus
o Projects upward and to left of cardiac orifice
o In supine position, fundus usually lies posterior to the L 6th rib
in the plane of MCL

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 9 of 17

 Body of the Stomach

o Extends from level of cardiac orifice to level of inciscura
angularis
o Largest region of the stomach
o No definite bifurcation from body to pylorus
o Incisura angularis (angular inscisure) constant notch in lower
part of the lesser curvature; (L) of the midline; junction of body
and pyloric part of stomach
Pyloric Part funnel-shaped region; lies at the transplyoric plane
o Pyloric antrum wide part; extends from incisura angularis to
the pylorus; narrows to form the pyloric canal
o Pyloric canal narrow part; ends at pyloric sphincter
o Pylorus sphincteric region
Thickening of inner circular muscle
Tubular part of stomach containing pyloric sphincter, thick
muscular wall of pylorus which controls the rate of discharge
of stomach contents into duodenum
Recognized externally as slight constriction on stomach
Lies on (r) side
o Pyloric orifice outlet of the stomach
B. Openings of the Stomach
Cardiac
o Where esophagus enters stomach
o Has physiologic sphincter only
Pyloric
o Formed by pyloric canal
o Thicker muscular coat (circular)
o With both anatomic and physiologic sphincter
C. Curvatures of the Stomach
Greater curvature
o From left of cardiac orifice, over dome of fundus, to pylorus and
along left border of the stomach to the pylorus
o Much longer than lesser curvature
o It passes inferiorly to the left from the junction of the 5th ICS
and MCL, then curves to the right, passing deep to the 9th or
10th left cartilageas it continues medially to reach the pyloric
antrum
Lesser curvature
o Shorter, concave, right border of stomach
o From cardiac orifice to pylorus
o Angular Incisure most inferior part of the curvature, indicates
the junction of the body and pyloric part of the stomach
o Suspended from liver by lesser omentum
D. Omenta
Mobile
Could adhere to possible infection
Temporarily prevents spread of infection (not useful in children
below 2yo since their omenta is not yet well developed)
Greater omentum from greater curvature of the stomach to
other viscera; has 3 parts:
o Gastrocolic ligament colon
o Gastrosplenic ligament spleen
o Gastrophrenic ligament diaphragm
Lesser Omentum suspends the lesser curvature os the stomach
from the fissure of the ligamentum venosum and the porta
hepatic on the undersurface of the liver:
o Hepatogastric or Gastrohepatic ligament connects lesser
curvature of the stomach to the liver; membranous portion of
lesser omentum; proximal part ; thicker

o Hepatoduodenal ligament connects the proximal part of the

duodenum to the liver; thickened free edge of the lesser
omentum; conducts the portal triad: portal vein, hepatic artery
and bile duct; distal part; narrower
Stomach bed on which stomach rests when person is in supine
position, is formed by the structures forming the posterior wall of
the omental bursa
o from superior to inferior:
Left dome of diaphragm
Spleen
Left kidney and suprarenal gland
Splenic artery
Pancreas
Transverse mesocolon
E. Blood Supply
From branches of celiac artery/trunk
Left gastric artery
o Directly from celiac artery
o Supplies lower 1/3 of esophagus and upper right (lesser
curvature) of stomach
Right gastric artery
o From hepatic a., a branch of celiac trunk
o Supplies right portion of thelesser curvature of stomach
Short gastric artery
o From splenic a., a branch of celiac trunk
o Supplies fundus
Left gastroepiploc (gastro-omental) artery
o From splenic artery
o Supplies stomach along the left portion of the greater
curvature
Right gastroepiploc (gastro-omental) artery
o From gastroduodenal branch of the common hepatic artery
o Supplies right portion of the greater curvature

Figure 15. Blood Supply of stomach

F. Venous Drainage
Right and Left Gastric veins
o Drain directly into hepatic portal vein (at neck of pancreas, L1,
L2)
Short gastric and Left gastroepiploic or gastro-omental veins
o Join splenic vein, which drains into the superior mesenteric vein
(SMV) to form the hepatic portal vein
Right gastroepiploic or gastro-omental vein
o Drains into the superior mesenteric vein
Note:
- Portal vein is formed by the union of superior mesenteric vein
and splenic vein.
- Prepyloric vein: ascends over pylorus to drain to right gastric
vein; being use by surgeons to identify the pylorus

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 10 of 17

o Inner circular encircle body of stomach, thickened at pylorus,

few in the fundus, forms the pyloric sphincter (middle circular
muscle layer) which regulates flow of chime from stomach to
first part of duodenum
o Outer longitudinal most superficial, concentrated along
curvatures
Visceral peritoneum
o completely surrounds the stomach
o leaves lesser curvature as lesser omentum
o leaves greater curvature as gastrosplenic omentum and greater
omentum

Figure 16. Venous drainage of stomach

G. Lymph Drainage
Gastric Lymphatic Vessels follow the arteries along the greater
and lesser curvatures to:
o Left and right gastric nodes
o Left and right gastroepiploic nodes
o Short gastric nodes
All lymph from stomach eventually passes toceliac
nodeslocated around root of celiac artery on posterior
abdominal wall
Celiac node cysterna chili thoracic duct
Clinical Correlation
In carcinoma of the stomach, the spread of cancer is hard to contain
because lymph nodes are shared
H. Nerve Supply
Parasympathetic vagus nerve
o Secretory nerve fibers to glands and muscles
o Anterior vagal trunk anterior surface of stomach, pyloric
branch to pylorus (Left)
o Posterior vagal trunk posterior (main) and anterior surface
of stomach (Right)
Sympathetic celiac plexus / thoracic splanchnic nerves
o Pain transmitting nerve fiber
o Greater splanchnic T6-T9
o Lesser splanchnic T10-T11
o Least splanchnic T11
H. Histology of the Stomach
Mucous membrane
o Thick and vascular
o Rugae numerous folds of the mucous membrane of stomach,
longitudinal in direction
o Magenstrasse
Pliable, linear rugal folds or groove of the gastric mucosa
along the lesser curvature that is the route food and liquids
tend to take in moving toward the pylorus
Has no oblique muscles
Bounded externally by the gastrohepatic ligament
Frequent site of most spontaneous gastric rupture (peptic
ulcer formation), due to the lesser curvature's lower
distensibility
Muscular walls
o Oblique innermost coat, loop over fundus and pass down
along anterior and posterior walls, parallel with lesser
curvature; not seen in curvatures

LOWER GASTROINTESTINAL TRACT

II. SMALL INTESTINE
Greatest surface area (22 ft. long)
From the pylorus of the stomach to the ileocecal junction where
the ileum joins the cecum (first part of the large intestine)
Pyloric part empties in duodenum and pylorus regulates duodenal
admission
Where the greater part of digestion and food absorption takes
place

Figure 17 . Three Parts of small intestine: Duodenum, Jejunum, Ileum

A.DUODENUM
First part of the small intestine and the shortest one
10 in. (25 cm) long
Also the widest and most fixed part
C-shaped tube that course around the pancreas and joins the
stomach to the jejunum
Runs from pylorus on right side to the duodenojejunal junction
/flexure (an acute angle) on the left
Junction occurs at the level of the L2 vertebra, 2-3 cm to the left
of the midline
Receives the openings of the bile and pancreatic ducts
Situated in the epigastric and umbilical regions
First part is smooth; remainder is thrown into circular folds called
theplicae circulars
Most of the duodenum is fixed by peritoneum to structures on
the posterior abdominal wall and is considered
partiallyretroperitoneal except the 1st inch that is
intraperitoneum
Parts of the Duodenum
o SUPERIOR: FIRST PART
2 inches (5 cm) long ,Lined by smooth mucous membrane
Ascends from the pylorus and is overlapped by the liver and
gallbladder
runs upward and backward on the right side of the first
lumbar vertebra (L1)
Lies on thetranspyloric plane

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 11 of 17

 Anterior aspect covered by peritoneum but posterior part is

bare, except for the ampulla
Proximal part has thehepatoduodenal ligament attached
superiorly and the greater omentum attached inferiorly
Note:
- AMPULLA or DUODENAL BULB - it is the only portion of
the duodenum that is mobile since it is suspended by a
mesentery. The rest of the duodenum is retroperitoneal,
applies to the first inch of the duodenum

o ASCENDING: FOURTH PART

curves anteriorly to join the jejunum at duodenojejunal
flexure supported by the suspensory muscle of duodenum
(suspensory ligament of Treitz)
2 in. (5 cm) long
Begins at the left of the L3 vertebra and rises superiorly as far
as the superior border of the L2 vertebra
Runs upward and to the left to the duodenojejunal flexure
Suspensory ligament of Treitz
-peritoneal fold which holds the duodenojejunal flexure in
place, attaching to the right crus of the diaphragm
-composed of a slip of skeletal muscle from the diaphragm
and a fibromuscular band of smooth muscle from the third
and fourth parts of the duodenum
-contractions of the muscle widens the angle of the
duodenojejunal fixture, facilitating movement of the
intestinal contents
-passes posteriorly through the pancreas and splenic vein
and anterior to left renal vein

Table7 . Boundaries of superior duodenum

Anterior
quadrate lobe of the liver and gallbladder
Posterior
lesser sac, gastroduodenal artery, bile duct portal vein,
IVC
Superior
epiploic foramen
Inferior
head of the pancreas

o DESCENDING: SECOND PART

Longer than superior part 7- 10 cm long and descends along
the right sides of L1 L3 vertebra
Runs vertically downward in front of the hilum of the right
kidney at the right side of L2 and L3
Appearance ofplicaecirculares or valves of Kerckring,Entirely
retroperitoneal
Peritoneum reflects from its middle third to form the double
layered mesentery of the transverse colon, the transverse
mesocolon
Plicaecirculares or Valves of Kerckring: Increase the surface
area of small intestine for absorption
Hepatopancreatic ampulla or Ampulla of Vater: Formed
where the bile duct and pancreatic duct enter the
posteromedial part of the second duodenum, opening into
the duodenal papilla
Major duodenal papilla: Small, rounded elevation where the
bile duct and the main pancreatic duct pierce the medial wall
of the duodenum
Minor duodenal papilla: Where the accessory pancreatic
duct opens. This part of the duodenum is not present if the
pancreatic duct has no accessory part
Table 8. Boundaries of superior duodenum
Anterior
fundus of the gallbladder, right lobe of the liver, transverse
colon, SI
Posterior
hilum of the right kidney, right ureter
Lateral
ascending colon, right colic flexure, right lobe of the liver
Medial
head of the pancreas, bile duct, main pancreatic duct

o INFERIOR/ HORIZONTAL: THIRD PART

3 in (8 cm) long
Runs transversely to the left, passing over the IVC, aorta, and
L3 vertebra
Runs horizontally to the left on the subcostal plane
Crossed by the superior mesenteric artery and vein and the
root of the mesentery of the jejunum and ileum
Anterior surface is covered by peritoneum except where it is
crossed by the superior mesenteric vessels and the root of
the mesentery
Table 9. Boundaries of inferior duodenum
Anterior
root of the mesentery of SI, superior mesenteric vessels,
jejunum
Posterior
separated from the vertebral column by the right psoas
major, IVC, aorta, and right testicular or ovarian vessels
Superior
head of the pancreas and its uncinate process
Inferior
jejunum

Table10 . Boundaries of ascending duodenum

Anterior
beginning of the root of the mesentery, coils of jejunum
Posterior
left margin of the aorta, medial border of the left psoas
muscle.

B .JEJENUM and ILEUM

Figure 18. Jejenum and ileum

has no clear line of separation and together, is 6-7 m long

Runs from the duodenojejunal junction to the ileocecal junction
Its coils are freely mobile
Attached to the posterior abdominal wall by a fan-shaped fold of
peritoneum known as mesentery of the small intestine
Mesentery a fan-shaped fold of peritoneum that attaches the
jejunum and ileum to post. Abdominal wall
Root of the mesentery
o (approx. 15 cm long) attached to posterior abdominal wall from
L2 to the right sacroiliac joint. It conveys nerves and blood
vessels
o between the two layers of mesentery are superior mesenteric
vessels, lymph nodes, variable amount of fat, autonomic nerves
Peyer's patches: aggregated lymphoid nodules that could be used
to distinguish the ileum from the duodenum and jejunum.
JEJENUM
o second part of small intestine and begins at duodenal flexure
where digestive tract resumes an interperitoneal course
o 8 feet long Forms the upper 2/5 of the interperitoneal section
(jejunuileum)
o double layer of peritoneum
o mostly lies in left upper quadrant of infracolic compartment

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 12 of 17

 ILEUM
o third part of small intestine and ends at ileocecal junction
(union of the terminal ileum and cecum)
o 12 feet long
o Forms the lower 3/5 of the jejunuileum,
o Ends at ileocecal junction
o mostly lies at right lower quadrant

II. LARGE INTESTINE

Extend from the ileocecal junction to the anus
Primary function: absorption of water and electrolytes; storage of
undigested material until it can be expelled from the body as
feces
Parts: cecum, ascending colon , transverse colon, descending
colon, sigmoid colon, rectum and anal canal

CLINICAL CORRELATON
Meckel's diverticulum

Congenital anomaly.
Persistent vitellointestinal duct
Small bulge or malformation found in the terminal 2 ft. of the ileum
Usually asymptomatic, but can sometimes form an intestinal
obstruction
May develop inflammation that can be confused with appendicitis
(Meckel's Diverticulitis), mimicking its signs and symptoms
In distinguishing the jejunum from the ileum in
radiographs, note that the JEJUNUM has a feathery
appearance while the ILEUM has a solid appearance.
Table 11. Summary of the differences between jejunum and ileum

Figure 19. Terminal ileum and large intestine

Can be distinguished from the small intestine by:

o Omentum appendices: small, fatty, omentum-like projections
o Teniae coli: 3 distinct longitudinal thickened bands of smooth
muscle
Mesocolic tenia to which the transverse and sigmoid
mesocolon attach
Omental tenia to which the omental appendices attach
Free tenia to which neither mesocolons nor omental
appendices are attached.
o Haustra: sacculations of the wall of the colon between teniae
These are formed due to teniae coli being shorter than the
entire length of the large intestine
o A much greater calibre (internal diameter)
Teniae, haustra, and fatty omentum appendices characteristic of
the colon are not associated with the rectum
A.CECUM
Blind intestinal pouch at the iliac fossa of the right lower quadrant
abdomen (lies within 2.5 cm of the inguinal ligament)
Approx 7.5 cm in both length and breadth
Palpable through the anterolateral abdominal wall if distended
with feces and gas
Devoid of mesentery and it is freely movable
completely covered with peritoneum
Bound to the lateral wall by cecal folds of peritoneum
o Ileal orifice - the opening at the junction of the ileum and
cecum. It has two lips, one above and one below called the
ileocolic lips.
o Ileocecal valve two folds or lips that project around the
orifice of ileum; rudimentary structure usually mistaken as the
structure responsible for preventing the reflux of food back into
the ileum, when it is actually the ileocecal sphincter that does
the job.
o Frenulum a fold that runs from the ileocecal valve along
o the wall at the junction of the cecum and ascending colon
Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 13 of 17

Table12 . Boundaries of cecum

Anterior
Posterior
Medial

Small intestine, greater omentum, anterior

abdominal wall in the right iliac region
Psoas and iliacus major, femoral n., lateral
cutanoues nerve of the thigh
Appendix

B. APPENDIX
Blind intestinal diverticulum (6-10cm) that contains masses of
lymphoid tissue
Arises from the posteromedial aspect of the cecum inferior to the
ileocecal junction
Attached to lower layer of the mesentery of SI by a short
mesentery of its own called mesoappendix
Usually retrocecal but variations may occur
In relation to the anterior abdominal wall, its base is situated 1/3
of the way up the line joining the RIGHT ASIS to the umbilicus
(McBurneys point)
Anatomical position of the appendix will determine the site of
muscular spasm and tenderness in appendicitis
C. ASCENDING COLON
Location:
o lies in the right lower quadrant;
o Extends upward from the cecum to the inferior surface right
lobe of the liver
Turns to the left at the right colic flexure /hepatic flexure (lies
deep to the 9th and 10th rib) and becomes continuous with the
transverse colon.
Retroperitoneal
Greater omentum separates the ascending colon from the
anterolateral abdominal wall
Right paracolic gutter deep vertical groove lined with parietal
peritoneum that lies between the lateral aspect of the ascending
colon and the adjacent abdominal wall (see Figure 2.49 page 245
of Moore)
Narrower than cecum
Table13 . Boundaries of ascending colon
Anterior
SI, greater omentum, anterior abdominal wall
Posterior
Iliacus, iliac crest, quadrates lumborum, origin of
tranversus abdominis muscle and right kidney.
Iliohypogastric & ilioinguinal nerves cross behind it

C. TRANSVERSE COLON
Longest and most mobile part of the large intestine
Location:
o crosses the abdomen from right colic flexure left colic
flexure
o hanging to the level of the umbilicus (L3)
-in tall, thin people, it may extend in to the pelvis
left colic flexure/ splenic flexure
o more superior, more acute and less mobile than the right colic
flexure
o anterior to the inferior part of the left kidney
phrenicocolic ligament suspends the splenic flexure from the
diaphragm
transverse mesocolon mesentery of the transverse colon,
suspends the transverse colon from the pancreas
root of the transverse mesocolon along the inferior border of
the pancreas and continuous with the parietal peritoneum
posteriorly

Table14 . Boundaries of transverse colon

Anterior
Greater omentum, anterior abdominal wall
nd
Posterior
2 part of duodenum, head of pancreas, coils of
duodenum and ileum

D. DESCENDING COLON
Location:
o Lies in the left upper and lower quadrants
o extends downward from the left colic flexure left iliac fossa
or pelvic brim
Retroperitoneal
Has a left paracolic gutter on its lateral aspect
Covered anteriorly and laterally and attached to the posterior wall
by the peritoneum
Table15 . Boundaries of descending colon
Anterior
SI, greater omentum, anterior abdominal wall
Posterior
Lateral border of left kidney, origin of tranversus
abdominis ms, quadrates lumborum, iliac crest, iliacus
and left psoas.
Iliohypogastric, ilioinguinal, lateral cutaneous of the thigh
and femoral nerve

E. SIGMOID COLON
S-shaped loop, links descending colon and rectum
Location: extends from iliac fossa S3, where it joins the rectum
Rectosigmoid junction termination of teniae coli, approx 15cm
from anus
Sigmoid mesocolon long mesentery of sigmoid colon; attaches
the sigmoid colon to the posterior pelvic wall
Root of the sigmoid mesocolon inverted V-shaped attachment,
extending first medially and superiorly along the external iliac
vessels and then medially and inferiorly from the bifurcation of
the common iliac vessels to the anterior aspect of the sacrum.
Distinguising characteristics
o Teniae coli disappears and then come together to form a broad
band of longitudinal fibers in the walls of the rectum
o Omental appendices are long
Table 16. Boundaries of sigmoid colon
Anterior
Urinary bladder (males), poetrior surface of the uterus
and upper part of vagina (females)
Posterior
Rectum, sacrum, lower coils of the terminal ileum

F.RECTUM
pelvic part of digestive tract, 5 in. (13cm) long
follows the curvature of the cecum
extends from S3 up to the area where it pierces the levator ani
muscle
peritoneum covers the anterior and lateral surfaces of the upper
1/3 of the rectum and only the anterior surface of the middle 1/3,
leaving the lower 1/3 devoid of peritoneum because it is
subperitonium
is S-shaped when viewed laterally
has NO mesentery, sacculations (haustra of the colon), taenia
coli, appendices epiploicae
continuous proximally with the sigmoid colon, distally with the
anal canal.
lying anterior to the S3 vertebra is the rectosigmoid junction,
where (a.) teniae of the sigmoid colon spreads forming a
continuous outer longitudinal layer of smooth muscle, and (b.)
fatty omental appendices are discontinued

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 14 of 17

 lies posteriorly against the inferior three sacral vertebrae and the
coccyx, anococcygeal ligament, median sacral vessels, inferior
ends of the sympathetic trunks and sacral plexuses
Rectal valves- support the weight of the feces and prevent overdistention of rectal ampulla (2 on the left namely the superior and
inferior rectal valves and 1 on the right called the middle rectal
valve)
Rectal ampulla distal dilated portion above the levator ani
muscle; NOT covered by peritoneum (proximal third is covered
anteriorly and laterally by pelvic peritoneum, the middle third is
covered ONLY ON ITS ANTERIOR aspect by the peritoneum)
In Males: the peritoneum that covers the rectum goes down and
covers the posterior aspect of the urinary bladder forming the
floor of rectovesical pouch
o rectum is related anterorly to the fundus of the urinary
bladder,terminal parts of the ureters, ductus deferentes,
seminal glands and prostate
For Females: the peritoneum that covers the proximal 2/3 of the
rectum covers the posterior fornix of the vagina to form the
rectouterine pouch (Pouch of Douglas)
Pararectal fossae
o (one in the right and one in the left) formed in the lateral
reflections of the peritoneum from the superior third of the
rectum (in BOTH sexes); permit the rectum to distend as it fills
with feces
o follows the curve of the sacrum and coccyx forming the sacral
flexure of the rectum
o ends anteroinferior to the tip of the coccyx that perforates the
pelvic diaphragm, immediately before the sharp posteroinferior
angle of the anorectal flexure of the anal canal (an important
mechanism for fecal continence)
o apparent anteriorly are the three sharp lateral flexures of the
rectum (superior and inferior-on the left side, intermediate-if
right)
o flexures are formed in relation to three internal infoldings
(transverse rectal folds/valves of Houston): two on the left,
one on the right;
Transverse rectal folds
o overlie thickened parts of the circular muscle layer of the rectal
wall
o support the weight of fecal matter to prevent its urging toward
the anus
o superior to and supported by the pelvic diaphragm (levator ani)
and anococcygeal ligament
o receives and holds fecal mass until it is expelled during
defecation
o ability to relax to accommodate initial and subsequent arrival
of fecal material is important in maintaining fecal continence
G. ANAL CANAL
1.5 in. (4cm) long
extends from the superior aspect of levator ani muscleor pelvic
diaphragm down to the anal orifice (anal verge) outlet of the
alimentary canal
begins where the rectal ampulla abruptly narrows at the level of
the U-shaped sling formed by the puborectalis muscle
lateral walls are kept in apposition by the levatores ani muscles
and the anal sphincters except during defecation
Dendate line- lower border of anal column joined by anal
valves;important landmark (derivative if ABOVE: HIND GUT, if
BELOW: ECTODERM)

surrounded externally by internal and external anal sphincter

(internal anal sphincter in the proximal 2/3 is made up of smooth
muscles; thickened distal portion of the inner circular muscle layer
of the anus)
Conjoined longitudinal muscle distal end of the outer
longitudinal muscle layer that separates the internal from
external anal sphincter
External anal sphincter is voluntary, supplied by inferior rectal
nerve; internal anal sphincter is involuntary (visceral
innervations)
Anal column-proximal third are ridges that contain the terminal
branches of the superior rectal muscle
in the submucosa of the proximal third of anus, the internal
venous plexuses are found
superior end of anal column corresponds to the anorectal line
(where the lining epithelium from simple columnar epith. with
goblet cells of the rectum changes to stratified squamous epith. In
the anal canal)
lining epithelium DOES NOT change at the area of dendate line
Anal Valves- connect the inferior end of anal column
Anal Crypts- spaces or depressions superior to anal valves into
which the secretion of perianal gland are emptied (important in
BRONCHOTITIS and formation of FISTULA EDEMA)
White Line of Hilton- corresponds to the area where the
conjoined longitudinal muscle attaches to the mucous membrane
of the anal canal
Anal pecten the transitional zone between the skin and the
mucous membrane; between the pectinate line and the anal
verge
Surgical anal canal from anocutaneous line to the anal verge
Anatomical anal canal portion from dendate line (pectinate
line/anatomic anorectal line) down to the anal verge
Table17 . Difference between small and large intestine
Small Intestine (SI)
Large Intestine
EXTERNAL
Mobile (except duodenum)
Ascending and descending are fixed
Located centrally
Located in the periphery
Smaller calibre
Larger caliber
Mesentery (except duodenum)
Mesocolon (transverse, mesocolon,
mesoappendix, mesosigmoid)
Continous layer of longitudinal
Longitudinal muscle is collected into
muscles
3 bands, the teniae coli (except in
the appendix, where the longitudinal
ms are continous, teniae are absent
in the rectum
Wall is smooth
Haustra or sacculations bet the
teniae are present
No fatty tags attached to its wall
Appendices epiploicae/omentum
appendices (fatty tags) are present
INTERNAL
Plicae circularis (valve of Kerckring)Plicae circulars are absent, has
permanent infoldings of the mucous
semilunar folds called anal valve at
membrane
the anal canal
Has villi in the mucosa
No villi
Peyers patches (aggregations of
No Peyers patches, appendix
lymphoid tissue) are present in the
contains lymphoid tissue
mucosa

III. BLOOD SUPPLY

first paired branch of the abdominal aorta is the right and left
phrenic artery
1cm below the take off of the right and left inferior phrenic artery
is the celiac trunk

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 15 of 17

A.CELIAC TRUNK
Artery of the foregut supplies GIT from lower of esophagus to
middle 2nd part of duodenum
Arises from Abdominal aorta T12
Branches:
1. Left Gastric A.
o Goes all the way up to provide branches to the abdominal
portion of the esophagus and occupies the upper lesser
curvature of the stomach
o Anastomose with Right Gastric A.
2. Splenic A.
o Going to the spleen via behind the stomach and upper
border of pancreas
o Gives rise to
Left Gastroepiploic A- supply the greater curvature;
Short Gastric A - supply the fundus and greater curvature;
some branches to pancreas including the dorsal
pancreatic artery
3. Common Hepatic A.
o Runs to the right along the upper border of pancreas
o Gives rise to
Right Gastric A., - supply the other part of lesser curvature
and pyrolus of stomach
Proper Hepatic A., that enters the portal triad, and
Gastroduodenal A.

B.SUPERIOR MESENTERIC ARTERY

Supplies the GIT from the 2nd part of duodenum to distal 1/3 of
Transverse colon
Artery of the midgut that arise infront of Abdominal Aorta below
Celiac Trunk
Branches:
1. Inferior pancreaticoduodenal A.
o supply the pancreas and inferior half of duodenum
2. Middle Colic A
o supply the proximal 2/3 of the transverse colon and divides
into right and left branches
3. Right Colic A.
o often a branch of Ileocolic A. that supply the ascending colon
and further divide into ascending and descending
4. Ileocolic A.
o The inferior branch is further divided into Anterior cecal a.
and posterior cecal artery that supply the Cecum
o The appendicular a. supply the appendix is arises from the
posterior cecal artery.
5. Intestinal A.
o Jejunal and Ileal branches: series of arcades in the small
intestines particularly jejunum and ileum

C. INFERIOR MESENTERIC ARTERY

Artery of the hindgut
distributes to the distal 1/3 of transverse colon to halfway down
of anal canal
Also a abdominal aorta branch that crosses the left common iliac
artery.
Branches:
1. Left Colic A.
o supply the distal 1/3 of transverse colon, left colic flexure,
and proximal half of descending colon
2. Sigmoid A
o supply the distal of the descending colon and sigmoid
colon
3. Superior Rectal A
o supplies the superior part of the rectum
o Anastomose with middle and inferior rectal artery
o Termination of inferior mesenteric artery
Note: MARGINAL ARTERIES of DRUMMOND anastomoses between
superior and inferior mesenteric artery
D. RECTAL ARTERY
Middle Rectal A
o Supply the middle and inferior rectum
o Arises from the inferior vesical (male) or uterine (female)
arteries, both are branches of internal iliac artery.
Superior Rectal Artery
o continuation of inferior mesenteric artery that supplies the
rectum and the upper half of anal canal
Inferior Rectal Artery
o Supply the anorectal junction and anal canal
o Arises from the internal pudendal artery ( a branch of internal
iliac A.)
IV. VENOUS DRAINAGE
Note: Veins follow the arterial blood vessels, even the names.
They eventually drain into superior and inferior mesenteric
veins, then to hepatic portal vein.
Through the portal vein (which is formed by the splenic and
superior mesenteric veins, behind the neck of the pancreas at L2)
liver sinusoids hepatic v. inferior vena cava
Superior mesenteric and inf. Mesenteric v.: follows the
corresponding arteries
Sup. mesenteric and inf. mesenteric veins drain to the hepatic
portal vein portal systemic anastomosis
Portal - systemic anastomoses
o Esophageal branches of the left gastric vein (portal)
esophageal draining middle third of the esophagus into azygos
v (systemic)
o Paraumbilical v (portal) superficial v. of anterior abdominal
wall (systemic)
o Superior rectal v. (portal tributary) middle and inferior rectal
v. (systemic)
o Retroperitoneal v. of ascending, descending colon, pancreas
and liver (portal) renal, lumbar and phrenic v, (systemic)
above the pectinate line, all the lymph will find its way into your
intestinal trunk which is one of the tributaries of thoracic duct

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 16 of 17

V. LYMPHATIC DRAINAGE
Follows the arterial vessel mesenteric nodesceliac
nodesmesenteric duct
Lumbar nodes: drains lymph from rectum, descending colon
Superficial inguinal nodes and ext. iliac nodes: below the
pectinate line, anal canal
Internal iliac nodes: upper canal (drains into inf. mesenteric
nodes)
Lacteals - specialized lymphatic vessels in the intestinal villi that
absorb fat that empty milk-like fluid to lymphatic plexuses in the
walls of jejunum and ileum
o lacteals mesentery lymph passes through 3 groups of
nodes: Juxta-intestinal (close to intestinal wall), Mesenteric
lymph nodes (scattered among arterial arcades) and superior
central nodes (located along proximal part of superior
mesenteric artery) superior mesenteric lymph node
lymphatic vessels from terminal ileum follow ileal branch of
ileocolic artery to the ileocolic lymph nodes
VI. NERVE SUPPLY
Parasympathetic
o From VAGUS nerve
o From SACRAL PLEXUS, S2 to S4
o The vagus nerves supply preganglionic parasympathetic
innervation up to the splenic flexure and then the sacral
parasympathetic nerves (S2-S4) take over
o Postganglionic neurons are located within the walls of the
organs (Meissners and Auerbachs plexus) where
postganglionic fibers are given off
Sympathetic
o From pelvic splanchnic nerves
o Sympathetic innervation is provided by the preganglionic
greater (T5-T9), lesser (T10-T11) and least (T12) splanchnic
nerves pass through the diaphragm and synapse at the
prevertebral ganglia (celiac, superior and inferior mesenteric)
and postganglionic fibers follow the branching of the arteries.
o Additional preganglionic sympathetic fibers from the lumbar
splanchnic (L1-L2-L3) synapse at the postganglionic neurons
inferior mesenteric ganglion to supply postganglionic fibers to
the lower digestive tract and the pelvic organs
Plexuses formed by the Parasympathetic and Sympathetic Nerve
Fibers in Walls of Intestines are:
o Auerbachs plexus
Located between inner circular and outer longitudinal layers
of muscle
Regulates peristalsis
o Meissners plexus
Innermost, in the submucosa
Regulates glands of mucosa and smooth muscles of
muscularis mucosae

Group 4 |Baes, Ballero, Baluyot, Banas, Bandoma, Baranda, Borzaga, Bautista, C., Baustista, B.

Page 17 of 17