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ANATOMY OF

GASTROINTESTINAL SYSTEM
Ahmad Azwar Habibi
Lab.Anatomi FKIK UINSH

TOPICS
Competencies of GI system SKDI
Overview:
Gastrointestinal tract
Accessory organ

Biomedical and Clinical Anatomy


Case studies

SKDI : DAFTAR MASALAH

Diare
Nyeri perut
Perut kembung
Muntah
Sulit BAB/sembelit
Sakit dan sulit menelan
Mulut kering
Bau mulut
Sakit gigi
Sariawan
Bibir pecah-pecah

Sendawa
Cegukan
Nyeri ulu hati
Nyeri sesudah makan
Kelainan tinja
Ambein
Nyeri saat BAB
Gatal daerah anus
Perdarahan saat BAB
Nyeri daerah anus
Muntah darah
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SKDI : DAFTAR PENYAKIT

SKDI : DAFTAR KETRAMPILAN KLINIS

OVERVIEW :
GASTROINTESTINAL SYSTEM
Gastrointestinal
Tract (alimentary
canal/digestive tube)

The mouth, pharynx,


esophagus, stomach,
small & large
intestine.

Accessory digestive
organs
Teeth, tongue.
Digestive glands:
salivary glands, liver,
gallbladder,
pancreas.

GI SYSTEM ABDOMEN

Boundaries:
Superior: xyphoid process & costal margin
Posterior: vertebral column
Inferior: upper parts of the pelvic bones.

Layers of abdominal wall :

Muscles of anterior abdominal wall:


Flat muscles: External oblique, Internal oblique, Transverse
abdominal
Vertical muscles:Rectus abdominis, Pyramidalis
Sheath and aponeurosis.
Linea alba: attachment of deep layer of superficial fascia
and the three aponeurosis
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ORGANIZATION OF
THE RECTUS SHEATH

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ABDOMINAL WALL
INGUINAL REGION

Inguinal ligament
Inguinal canal
Structures passing
through the canal
(male & female)
Superficial inguinal
ring (annulus
inguinalis medial/
superficial)
Deep inguinal ring
(annulus inguinalis
lateral /profundus)
Conjoint tendon
Inguinal hernias:
direct & inderect
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PERITONEUM

A membrane that lines the walls of


the abdominal cavity and covers
much of the viscera.
Divided into:
Parietal peritoneum
Visceral peritoneum

Peritoneal folds: suspend the


organs; in the peritoneal cavity
intraperitoneal

Organs outside the peritoneal


cavity, with only one surface or part
covered by peritoneum
retroperitoneal

Peritoneal folds:
Omenta :the folds suspending
the stomach
Mesenteries: the folds
suspending the small and large
intestines
Ligament
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PERITONEUM

Peritoneal cavity: potential


space enclosed within the
peritoneum.

The peritoneal cavity is


divided into:
The greater sac
The omental bursa

Connected by omental
foramen (epiploic foramen of
Winslow)

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ABDOMINAL REGIONS AND QUADRANTS

Midclavicular
plane

Subcostal plane

Transtubercular
plane

(a
)

(b)

Divisions of the anterior abdominal wall for mapping the digestive


organs into abdominal cavity
(a) The nine surface regions of the anterior abdominal wall
(b) The abdominal viscera as they relate to the nine surface

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ABDOMINAL REGIONS AND QUADRANTS


(c) Simpler scheme of four
quadrants centered at the
navel

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GI TRACT : (1) MOUTH


Boundaries
Oral cavity :
roof, floor, base
lateral wall

Right/left to frenulum of
tongue opening of
submandibular glands
Opposite to the upper M2
opening of the parotid
duct
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(2) PHARYNX
Lies behind oral
cavity proper
Divide into 3 parts:
Nasopharynx:
posterior to
choane
Oropharynx:
posterior to oral
cavity
Laryngopharynx:
posterior to larynx
Open to esophagus at
the level C VI
vertebrae.

SWALLOWING MECHANISM ???

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(3) ESOPHAGUS

Muscular tube, + 25 cm
Begins as a continuation of the
pharynx, at the level of the
vertebra CVI.
Divided into 3 part : cervical,
thoracic, abdominal syntopy
with other organs?

Four location of esophageal


constriction:
Trachea & laryngeal nerve,
15 cm from the incisive
teeth
Aorta arch, 22 cm from the
incisive teeth
Left bronchus, 27 cm from
the incisive teeth
Diaphragm esophagus
hiatus, 37 cm from the
incisive teeth

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(4) STOMACH
J - shaped
Regions :
Cardia : opening of oesophagus
into the stomach)
Fundus (dome shape): area
above the cardiac opening
(orificium cardiaca)
Body of stomach (corpus)
Pylorus

Projection of region ?
Curvatura major - curvatura minor
Incisura cardiaca - incisura
angularis

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Relation to other organs (syntopy)

Fundus : within the curved of


diaphragm
Body : pancreas & descending
part of diaphragm
Greater curvature : lies in front
of the left suprarenal gland &
upper part of the left kidney
Lesser curvature : pancreas &
tuber omentale of the liver
Posterior surface: splenic artery
& vein
Anterior surface: abdominal
wall
Right surface: left & quadrate
lobes of the liver.
Left surface of the fundus:
spleen
Caudal part of the greater
curvature: transverse colon

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(5) SMALL INTESTINE


Extends from the pyloric
orifice of the stomach to the
ileocecal fold.
Duodenum
Jejunum
Ileum

The mesentery of small


intestine is a broad, fan
shaped fold of peritoneum.
Suspends the jejunum & ileum
from the posterior abdominal
wall by the root of mesentery.
Contents: jejunal & ileal
branches of superior mesenteric
vessels, autonomic nerve
plexuses, lymphatics, lymph
nodes, connective tissue fat.

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DUODENUM

C-shaped
Rounding the head of the pancreas
Retroperitoneal, except for its
beginning
Location: epigastric & umbilical region
Connected to the liver by
hepatodudenal lig.
Part of duodenum
Flexures:
Superior duodenal flexure
Inferior duodenal flexure
Duodenojejunal flexure: surounded by
a fold of peritoneum containing muscle
fibers ligament of Treitz

Internal part of duodenum:


Major duodenal papilla: common
entrance for the bile and pancreatic
ducts
Minor duodenal papilla: entrance for
the accessory pancreatic duct
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JEJUNUM & ILEUM


Jejunum
(proximal 2/5 of
jejunum-ileum;
mostly in left
upper quadrant)
Ileum (distal 3/5
of jejunumileum; mostly in
right lower
quadrant)
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CHARACTERISTIC OF JEJUNUM & ILEUM

Or windows

Mesentery of jejunum

Mesentery of ileum

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CHARACTERISTIC OF JEJUNUM & ILEUM


Characteristics

Jejunum

Ileum

Location

Upper left quadrant

Lower right quadrant

Diameter

2 4 cm

2 3 cm

Lumen

Wider

Narrower

Walls

Thicker and more vascular

Thinner and less vascular

Circular mucosal folds (plicae


circulares)

Larger and more closely set

Smaller and sparse

Windows present

No windows

Fat less abundant

Fat more abundant

Arterial arcade, 1 or 2

Arterial arcades, 3-6

Vasa recta, longer & fewer

Vasa recta shorter & more


numerous

absent

present

Mesentery

Lymphoid nodules
(Peyers Patches)

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(6) LARGE INTESTINE


Extends from the distal end of the ileum to the
anus.
Approximately 1.5 m long.
Parts of large intestine:

Cecum
Colon
Rectum
Anus

Appendix
epiploicae

Characteristic: appendices epiploicae, taenia


coli, sacculation (haustra), semilunar fold
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CECUM & APPENDIX

The appendix: narrow, hollow tube.


Connected to cecum at the
posteromedial wall of caecum; 2
cm inferior of ileocecal valve
Suspended by mesoappendix.

Haustr
a
Semilunar fold

A large blind sac


Location: right iliac fossa, inferior to
the ileocecal opening.
Continuous with the ascending
colon at the entrance of ileum
(ileocecal opening)
Ileocecal valves: fold of ileocecal
opening

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CECUM & APPENDIX

The Base of appendix: attached to the


posteromedial wall of caecum; 2 cm
inferior of ileocecal valve.

Surface marking of appendix: a point


about 2 cm below the junction of
transtubercular & right lateral plane.

McBurney point: surface projection of


the base of appendix.
The junction of lateral 1/3 and middle
2/3 of a line from anterior superior iliac
spine (SIAS) to the umbilicus.
Site of maximum tenderness of in acute
appendicitis
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APPENDIX

Position of the appendix:


a.
Pelvic
b.
Retrocecal
c.
Preilieal
d.
Postileal (retroileal)

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COLON
Colon consist of:
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
At the junction between:

ascending & transverse colon :


right colic flexure (hepatic flexure);
just inferior to the right lobe
Transverse & descending colon: left
colic flexure (splenic flexure); just
inferior to the spleen

Ascending & descending colon are


retroperitoneal
Transverse & sigmoid colon are
intraperitoneal

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Begins at the level


of vertebra SIII, at
the rectosigmoid
junction.
Retroperitoneal
position

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RECTUM
Peritoneal relations
Upper 1/3 of rectum is covered
by peritoneum
Middle 1/3 of rectum, is
covered only in anterior part.
The lower 1/3 of rectum is
devoid of peritoneum, and
dilated to form the ampulla
(ampulla recti). It lies posterior
to Douglas pouch (rectouterine
pouch) in females; and
rectovesical pouch in male.

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Terminal part of large intestine


Lies between the 2 ischiorectal fossae
The interior of the anal canal can be divided
into 3 parts:
Upper part (mucous):
Limited below by pectinate line
Anal columns (of Morgani) :
containing the terminal radicles of
superior rectal vessels
Anal sinuses: small pocket above
the anal valves
Pectinate line: the circular line of
attachment of the anal valves;
separated the internal & external
piles (haemorrhoids)
Middle part (transitionalzone /pecten)
Lies between the pectinate line &
the white line of Hilton
Lower part (cutaneus)
External anal sphincter: voluntary
control
Internal anal sphincter: involuntary

ANAL CANAL

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ACCESSORIES
DIGESTIVE ORGANS

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(1) TEETH

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(2) TONGUE

The anterior part is triangular in


shape apex of tongue (apex
linguae)
Separated into 2/3 anterior & 1/3
posterior of tongue by a V-shaped
terminal sulcus of tongue.
The terminal sulcus forms the
inferior of the oropharyngeal
isthmus, between oral and
pharyngeal cavity.
Papillae: filliform, fungiform,
vallate, foliate.
Vessels: lingual artery & vein

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MUSCLE OF THE TONGUE

Extrinsic muscle, originate outside of the


tongue and insert to the tongue:

genioglossus, hyoglossus, styloglossus


& palatoglossus muscles

Intrinsic muscle, originate and insert


within the tongue:

superior & inferior longitudinal,


transverse & vertical muscles.
Function: alter the shape of the tongue:
lengthening & shortening; curling &
uncurling its apex and edges; flattening
& rounding its surface.

INNERVATION

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SALIVARY GLANDS

Opens into oral cavity


Divide into: intrinsic &
extrinsic salivary glands
Intrinsic salivary glands:
glands of tongue,
palate, lips, dan pipi

Extrinsic glands:
parotid,
submandibular, and
sublingual glands

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PAROTID GLAND

The parotid duct


across the external
surface of masseter,
& penetrates
buccinator muscle.

It open into oral


cavity adjacent to
the crown of upper
molar 2

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SUBMANDIBULAR & SUBLINGUAL


GLANDS

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

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ACCESSORIES
DIGESTIVE GLANDS

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LIVER
Location: right
hypochondrium &
epigastric region or right
upper quadrant
Surfaces:
Diaphragmatic surface:
anterior, superior &
posterior direction
Visceral surface: inferior
direction. Covered by
visceral peritoneum
except in the fossa for
gallbladder & at the porta
hepatis.

The porta hepatis consist


of: hepatic artery proper,
portal vein, hepatic duct
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Lobes: divided into left & right


lobes by the gallbladder &
inferior vena cava. Includes
caudate lobe on the upper
part and quadrate lobe on the
lower part of liver.
Ligaments:

Falcicorm lig.: attach the


liver to the anterior
abdominal wall
Round ligament of liver:
degeneration of umbilical
vein
Triangular lig.( left & right):
attach the liver to the
diaphragm
Coronary lig.( anterior &
posterior): attach the liver to
the diaphragm
Hepatogastric lig: connect
the liver-stomach
Hepatoduodenal lig: connect
the liver-duodenum

Bare area of liver: an area


between the liver &
diaphragm which is devoid of
peritoneum.
Relation to other organs.

(The right colic flexure & colic


transverse)

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GALLBLADDER
Parts of gallbladder:
Fundus: may project
from the inferior border
of liver
Body of gallbladder.
Neck of gallbladder.
Duct: cystic duct
Hepatic duct & cystic
duct open to common
bile duct (ductus
coledochus) and
drains to descending
part of duodenum.

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GALLBLADDER
Projection to anterior
abdominal:
The fundus of
gallbladder can be
located at the angle
between the right
border of rectus
abdominis muscle and
the lower costal
margin of the
vertebrae C10.
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PANCREAS

Extends across the posterior


abdominal wall from the duodenum (on
the right) to the spleen (on the left)
Location: posterior to the stomach,
retroperitoneal.
It consist:
The head :within the C-shaped of
duodenum
The uncinate process: projection of
the lower part of the head,
posterior to the superior
mesenteric artery & vein
The neck: anterior to the superior
mesenteric artery & vein.
The body: anterior to abdominal
aorta
The tail ends as it passes between
layers of the splenorenal lig.

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PANCREAS

Tail

Body

Head

Pancreatic ducts:
Major pancreatic duct : begins in the tail of the pancreas. The main pancreatic duct
join the bile duct and forms the papilla of Vater, which enters the descending part of
the duodenum at the major duodenal papilla of Vater.
Minor pancreatic duct: drains into the duodenum, above the major duodenal papilla
at the minor duodenal papilla
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BLOOD SUPPLIES

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ARTERIAL SUPPLY OF THE GASTROINTESTINAL


VISCERA & ASSOCIATED ORGANS
The gastrointestinal viscera and associated organs are supplied by the
anterior branches of the abdominal aorta.
Celiac artery (celiac trunk): branches from the abdominal aorta below the
aortic opening (at the upper border of vertebra LI) and supplies foregut
derivatives.
abdominal part of esophagus, stomach, upper 1 parts of duodenum up to
duodenal papilla of Vater, liver, common bile duct, pancreas, spleen

Superior mesenteric artery: branches from the abdominal aorta at the


lower border of vertebra LI and supply midgut derivatives.
Lower 2 part of duodenum below the duodenal papilla of Vater, jejunum,
ileum, cecum, appendix , ascending colon, right of 2/3 transverse colon

Inferior mesenteric artery: branches from the abdominal aorta at


approximately vertebral level LIII and suplies hindgut derivatives.
Left of 1/3 transverse colon ,descending colon, sigmoid colon, rectum, upper
part of the anal canal above the pectinate line.
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ANTERIOR BRANCHES OF THE ABDOMINAL AORTA

Superior mesenteric
artery
Celiac
trunk
Superior mesenteric
artery
Inferior mesenteric
artery

Celiac trunk

Abdominal
aorta

FOREGU
T

AORTA
ABDOMINALIS

MIDGUT

HINDGU
T

Inferior mesenteric
artery

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CELIAC ARTERY (CELIAC TRUNK): BRANCHES


Left gastric artery:

Run downwards along the lesser curvature.


Branches: esophageal & gastric branches

Splenic artery:

Run along the superior border of the pancreas


Branches:
Short gastric artery: supply the fundus of the stomach
Left gastro-omental (gastroepiploic) artery: run along the greater curvature of the
stomach.
Pancreatic branches
Splenic branches

Common hepatic artery:


Right gastric artery: run along the lesser curvature
Hepatic artery proper. Near the porta hepatis it divides into:
right & left hepatic artery
Gastroduodenal artery. Downward to duodenum. Branches:
Supraduodenal artery
Right gastro-omental (gastroepiploic) artery: run along the greater curvature of the
stomach
Superior pancreaticoduodenal artery: supplies the head of the pancreas and the53
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duodenum.

Left gastric artery


Splenic artery
Common hepatic
artery

Celia
c
trunk

CELIAC TRUNK AND ITS BRANCHES

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SPLENIC ARTERY AND ITS BRANCHES


Short gastric artery

Gastro-omenta
(Gastroepiploic) artery
Splenic artery

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COMMON HEPATIC ARTERY & ITS BRANCHES


Right hepatic artery

Left hepatic artery

Proper hepatic artery


Gastroduodenal artery
Common hepatic artery

Right heparic artery

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SUPERIOR MESENTERIC ARTERY


Crossed anteriorly by the splenic vein & the neck of
pancreas.
Posterior to the artery: left renal vein, uncinate process
of the pancreas & inferior (horizontal) part of the
duodenum
Branches:
Inferior pancreaticoduodenal artery: the head of the pancreas & the
duodenum

Intestines arteries jejunal & ileai arteries


Ileocolic artery colic, cecal & appendicular branch
Right colic artery : the ascending colon & the right flexure colon
Middle colic artery: right 2/3 of the transverse colon
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SUPERIOR MESENTERIC ARTERY


& ITS BRANCHES
MIDDLE COLIC
ARTERY

INFERIOR PANCREATICODUODENAL
ARTERY
SUPERIOR MESENTERIC
ARTERY
JEJUNUM

RIGHT COLIC ARTERY

JEJUNAL
ARTERIES

ILEOCOLIC
ARTERY

ILEAL ARTERIES
APPENDICULAR ARTERIES

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INFERIOR MESENTERIC ARTERY


Branches:
Left colic artery: supplies the left 1/3 of the transverse colon & the
descending colon
Anastomose: middle colic & sigmoid arteries

Sigmoid arteries: supplies the lowest part of the descending colon


& the sigmoid colon
Anastomose: left colic artery & superior rectal artery

Superior rectal artery: supplies the rectum & canal anal above the
pectinate line
Divide into 2 terminal branch at the level vertebra SIII: right & left
brances.
Anastomose: middle rectal artery (branch of internal illiac artery) &
inferior rectal artery (branch of internal pudendal artery)

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INFERIOR MESENTERIC ARTERY


& ITS BRANCHES

RIGHT COLIC ARTERY

INFERIOR MESENTERIC ARTERY


SUPERIOR RECTAL ARTERY

SIGMOID ARTERIES

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VENOUS DRAINAGE
OF THE GASTROINTESTINAL VISCERA &
ASSOCIATED ORGANS

Venous drainage from the spleen, pancreas, gallbladder, and the


abdominal part of the gastrointestinal tract (except for the inferior
part of the rectum)

PORTAL VEIN

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PORTAL VEIN
Venous blood from stomach, duodenum, jejunum, ileum
colon, rectum, pancreas, gallbladder & spleen enters the
liver through hepatic portal vein sinusoids of liver
hepatic veins drains into inferior vena cava enters
the right atrium of the heart.
Formed by the union of the splenic vein & superior
mesenteric vein, at the level of the vertebra LII.
Course: passed posterior to the superior part of the
duodenum & enters the hepatic portal vein with the bile
duct & proper hepatic artery.
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PORTAL VEIN

PORTAL
VEIN

SPLENIC VEIN
INFERIOR MESENTERIC VEIN
SUPERIOR MESENTERIC VEIN

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VENOUS DRAINAGE OF THE ABDOMINAL PORTION OF THE


GASTROINTESTINAL TRACT

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PORTOCAVAL SYSTEM

Anastomosis (communication) between portal vein (portal system) with


the vena cava (caval system).
Forms collateral circulation in portal obstruction.
Important sites:
Abdominal part of the esophagus:
esophageal tributaries of the left gastric vein (portal) with esophageal
tributaries of the azygos & hemiazygos veins (systemic)

Umbilicus
paraumbilical veins (portal) & epigastric veins (systemic)

Bare area of liver


hepatic venules (portal) with the intercostal veins & phrenic vein
(systemic)

Posterior abdominal wall


Veins of retroperitoneal organs (portal) with the retroperitoneal veins of
the abdominal wall & the renal capsule (systemic)

Anal canal
superior rectal vein (portal) with the middle rectal & inferior rectal veins
(systemic)
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PORTOCAVAL SYSTEM
Tributaries to azygos vein

V. PORTA
ROUND LIG. (LIG. TERES
HEPATIS) &.PARAUMBICAL VEINS
Superficial veins on
abdominal wall
INFERIOR VENA
CAVA
SUPERIOR RECTAL
VEIN

INFERIOR RECTAL VIEN

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PORTOCAVAL SYSTEM
Portal vein obstruction portal hypertension
Caput medusae at the umbilicus
Esophageal varices at the gastroesophageal
junction
Haemorrhoids at the anorectal junction

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LYMPHATICS

Lymphatic vessels & nodes of the gastrointestinal tract & associated


organs pre aortic lymph nodes
Almost all the lymphatic vessels of the gastrointestinal viscera &
associated organs drained to thoracic duct
Run with arteries of the gastrointestinal viscera
Pre aortic lymph nodes contains :
Celiac nodes (nn.ll.coeliacus) :
Receive lymph from the foregut origin: gastric (nn.ll. gastrica), hepatic (nn.ll.
Hepatica) & pancreaticosplenic (nn.ll. Pancreaticolienalis) nodes
Also receive lymph from superior & inferior mesenteric nodes

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


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

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


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

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LYMPHATICS

Gastric nodes lies along lesser curvature. Receive lymph from the
esophagus, lesser curvature, posterior-anterior-inferior aspect of the
stomach.

Hepatic nodes lies with hepatic artery. Receive lymph from the
stomach, duodenum, liver, gallbladder & pancreas.

Pancreaticosplenic nodes lies along splenic artery. Receive lymph


from stomach, spleen & pancreas.

Mesenteric nodes lies along superior mesenteric artery. Receive


lymph from the jejunum & ileum (except from the terminal ileum)

Ileocolic nodes lies along ileocolic artery. Receive lymph from the
terminal ileum, appendix, cecum, ascending colon.

Transverse mesocolic nodes between transverse mesocolon.


Receive lymph from the transverse, descending & sigmoid colon.
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INNERVATION
Parasymphatetic :
Increase peristaltic movement
Increase secretion of the digestive glands
Symphatetic :
Inhibitory to peristalsis
Increase contraction of the sphincter muscle

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PARASYMPHATETIC
Constricts pupil
Inhibits tear
glands
Increases
salivation
Slows heart

SYMPHATETIC
Stimulates tear
glands
Dilates pupil
Inhibits
salivation,
increases
sweating
Accelerates heart
Dilates bronchi

Constricts
bronchi

Increases
digestive
function of
stomach
Increases
digestive
function of
intestine
Contracts
bladder

Decreases
digestive
functions of
stomach
Secretes
adrenalin
Decreases
digestive
function of
intestine
Inhibits bladder
contraction
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Biomedical and Clinical Anatomy


1.

Describe the nerves involved in taste !

2.

What is the relationship between the lingual nerve and the


submandibular duct?

3.

Why is m.genioglossus importance in maintaining an airway in the


unconcious patient?

4.

Why might a patient with carcinoma of the tongue complain a


severe earache?

5.

When someone has ill, why all the food taste bitter?

6.

Which potentially weak regions of the anterior abdominal wall are


sites for herniae?

7.

What anatomical differences are there between an indirect and


direct inguinal hernia?
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8.
9.

Why is the pain of early appencitis generalised and paraumbilical in site,


whereas later on in the course of the disease it is localised to the right iliac
fossa?
Explain the physical examamination of appendicitis correlate with anatomy!
(rovsing sign, psoas sign and obturator sign)

10.

Describe the vascularisation of gaster, pancreas and liver!

11.

How would you distinguish between jejunum and ileum?

12.

What are the distinguishing features of the large intestine compared to the
small intestine?

13.

Why might a patient with a cancer of the stomach present with obstructed
pancreatic drainage?

14.

Which region of the large bowel is most likely to suffer from ischemia and why?

15.

Why should a cancer of the head of the pancreas cause a patient to be


jaundiced?
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16.

Describe the most common arrangement in the formation of the


portal vein!

17.

Where are the main site of postosystemic venous anastomoses?

18.

Why must the patient hold his breath during liver biopsy?

19.

What is the embryological explanation of an emperforate anus?

20.

In performing a rectal examination on male or female, what


stucture might normally feel?

21.

Why may haemorroids be associated with cirrhosis of the liver


and if injected in the correct region, cause no pain?

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CASE STUDIES
1. Gastric ulcer
2. Liver abcess
3. Appendicitis

THANK YOU
SEE YOU IN THE LAB. PRACTICE
75

Maka hendaklah manusia memperhatikan makanannya


(QS Abasa 24)
Dia telah menciptakan sesuatu dan Dia juga menetapkan ukurannya
dengan serapi-rapinya
(QS al Furqaan: 2)

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REFERENSI
Kuliah Anatomi Gastrointestinal FKUI, FK
Unlam, PSPD FKIK UIN
Grays Anatomy
Textbook of Anatomy, Hollinshead
Clinical Anatomy for medical students, Snell
Grants Method of Anatomy
Pocket Examiner in Regional and Clinical
Anatomy, Abrahams
Case Studies in Anatomy, Lachman
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