Anatomi Sistem

Digestif (Blok BSDNS)

Fitranto Arjadi

Sistem Cerna

Copyright2001BenjaminCummings,animprintofAddisonWesleyLongman,Inc.

Figure14.1
Slide14.1
2

PERITONEUM
CAVUM PERITONEI :
Ruang potential diantara
peritoneum
parietale dan viscerale
TERDAPAT 2 MACAM ORGAN :
1. INTRAPERITONEAL
> luas permukaannya
diliputi peritoneum, biasanya
merupakan organ yang mobile
2. EXTRA/RETROPERITONEAL
< luas permukaan diliputi
peritoneum, biasanya
merupakan organ yang
melekat pada dinding
abdomen

Peritoneum & Mesenterium

Peritoneum(Selaput perut)

Visceral: menutup organ dalam rongga abdomen

Parietal: menutup permukaan dalam dinding tubuh
Retroperitoneal: dibelakang peritoneum seperti
ginjal, pankreas, Colon (usus besar)
(tak ada mesenterium)

Mesenterium

Meletakkan organ pada tempatnya

Jalur dimana saraf dan pembuluh darah berjalan dari
dinding badan ke organ.

Omentum : lipatan/kantong di dalam peritoneum

Omentum Mayus banyak lemak, dari kurvatura mayor lambung

dan colon transversalis
Omentum Minus berhubungan dg kurvature minor lambung dan
ujung
atas duodenum , hati , diafragma membentuk
mesenterium usus halus
5

Kesimpulan

Table 22.1

CAVUM ABDOMINOPELVICUS
Batas cavum abdominopelvicus :

Diaphragma

Dinding abdomen (anterior, lateral &

posterior )

Dinding pelvis ( os coxae & sacrum )

Diaphragma pelvis
Terdiri dari :
1.
Cavum abdominis
2.
Cavum pelvis
Kedua ruang dibatasi Pintu Atas Panggul /
aditus
pelvis, suatu bidang imaginer melalui tepi
atas
symphisis pubis dan promontorium
ISI :

ORGAN SYSTEMA DIGESTIVUS

SYSTEMA UROPOETICA
SYSTEMA GENITALIA INTERNA

CAVUM ORIS

Oris (mulut)
Luar : lobang mulut = Rima
Oris, dibatasi oleh bibir atas
(labium superius) dengan
bibir bawah (labium inferius)
Sudut rima oris dinamakan
Angulus Oris
Pertemuan labium superius
& Inferius disebut
Commisura Labiorum
Batas antara labium
superius ke lateral disebut
Sulcus Naso Labialis

- Lekukan tengah bibir atas :

Philtrum
- Bagian menonjol pada
pinggir atas bibir atas :
Tuberculum Labiale
- Labium oris dibentuk oleh :
- M. Orbicularis oris
- M. Triangularis
- Mm. Incisivus Labii Inf/sup
- Mm. Quadratus labii
inf/sup
- Perdarahan untuk bibir a:
A.a. Labialis Superiores &
Inferiores yang membentuk
circulus arteriosus oris

Cavum Oris
Ruang mulut,
lanjutan rima oris
- Terbagi atas
- Vestibulum oris
- Cavum oris proprium
- Batasnya dibentuk oleh :
- arcus dentalis superior
- arcus dentalis inferior
- proc. Alveolaris Inf
- proc. Alveolaris sup
- plica pterygo mandibularis
-

Vestibulum Oris
Ruangan antara bibir
dan pipi disebelah luar
dengan
proc. Alveolaris dan arcus
dentalis disebelah
dalam pipi (Buccal)
Dibentuk oleh :
M. Buccinatoria

Cavum Oris Proprium

- Terletak disebelah dalam dari vestibulum oris
- Atap dibentuk oleh :
1. Palatum Durum ( depan) dibentuk oleh :
- Proc. Palatinus Ossis Maxillaris
- Pars Horizontalis Palatini
2. Palatum Molle (belakang) terdiri dari
a. M. Palato Glossus
b. M. Uvulae
c. Aponeurosis Palatinus
- Dinding lateral dibentuk oleh
- Proc. Alveolaris
- Arcus Dentalis

Palatum Durum
- Dibentuk oleh :
- kedua Proc. Palatinus Ossis Maxillaris
- lamina horizontalis Ossis Palatinum
- Atas ditutup mucosa cavum nasi
- Bawah ditutup oleh mucoperiosteum yang
banyak mengandung pembuluh darah & saraf
- Belakang ; penuh Gl. Palatum yang bersifat
mucous
- Epitel keratinasi dan sensitif terhadap rasa raba.
- Pada mucoperiosteum terdapat raphe digaris
median mediannya yang berakhir di depan
pada papilla incisiva

Palatum Molle /Vellum Palatinum

- Merupakan lipatan fibromusculer yang
menggantung pada Bg Post Palatum Durum
dan mudah bergerak
- Memisahkan nasopharynx & cavum oris
- Berfungsi untuk menutup nasopharynx
waktu menelan dan pada waktu berbicara
- Ujung bawah bebas dan terletak pada garis
median berupa tonjolan panjang : Uvula

- Kearah lateral palatum molle

melanjutkan diri dengan 2 pasang
lipatan mucosa yaitu :
- arcus palatoglossus
- arcus palatopharyngicus
- Palatum mendapatkan darah dari :
- Aa. Palatina major
- (cabang A. palatina descendens
cabang A. Maxillaris)
- Mendapatkan persyarafan dari :
cabang-cabang N. Maxillaris melalui Gl.
Pterygopalatina

- Dasar Cavum Oris dibentuk oleh :

- M. Digastricus venter ant
- M. Mylohyoideus
- M. Genio Hyoideus
- Berhubungan dengan Oro-pharynx melalui
Isthmus Faucium yang dibentuk oleh :
- palatum mole
- arcus palatoglossus
- dorsum lingua
Isi Cavum Oris :
- Lingua (lidah)
- Gigi (dental)

OTOT LIDAH TERDIRI DARI :

I.

OTOT INSTRINSIK

Otot Intrinsik :
Yaitu otot-otot dalam lidah, terdiri atas :
a. M. Longitudinalis Sup & Inf
- Berjalan sepanjang lidah
- M. Longitudinalis Sup or kontraksi lidah membelok
keatas
- M. Longitudinalis Inf or kontraksi lidah membelok
kekiri
dan kekanan
b. M. Transversus
- Berjalan transversal antara M.m.Longitudinalis
Supor &Inf or
- Bila berkontraksi lidah menyempit dan memanjang
c. M. Verticalis
- Berjalan vertikal, lateral diantara M.m.
Longitudinalis
- Memipihkan lidah

Otot-otot extrinsik :
1. M. Genioglossus
- Mulai dari spina mentalis menuju ke lidah. Serabutserabutnya mengarah ke occipital
- Faal : Menarik lidah keluar
2. M. Hyoglossus
- Mulai dari corpus ossis hyoid ke lidah arah serabut :
dorsocaudal ventrocranial
- Faal : Menarik lidah kebawah & belakang
3. M. Styloglossus
- Mulai dari Proc. Styloglossus ke lidah
- Faal : Menarik lidah kebelakang atas
4. M. Palato Glossus
- Mulai dari pinggir depan palatum molle ke lidah
- Faal : Menarik lidah keatas

Pembagian Lidah :
- Apex Linguae
- Dorsum Linguae
- Radix linguae
- Facies Inf

Dorsum Linguae
Linea terminalis yang berbentuk huruf V
yang membuka ke frontal.
- Membagi Dorsum Linguae menjadi : Bagian
anterior & bagian posterior
- Dipuncak huruf V terdapat foramen caecum
yaitu sisa dari ductus Tyreoglossus
- Arcus Palato Glossus membagi lidah atas :
- Pars Pharyngeal
terdapat dalam
pharynx
- Pars Oralis terdapat dalam cavum oris
-

- Pada Dorsum
Linguae terdapat
tonjolan
(papillae)
Papilla Simplex
- Papilla Filiformis
:berbentuk
benang
- Papilla Foliata :
berbentuk
lembaranlembaran
- Papilla
Fungiformis :
Berbentuk
cendawan

Dorsum pada pars pharyngica menghadap ke post dan

pars oralis menghadap keatas

- Radix Lingua
bagian yang menempel pada dasar cavum oris
dilekatkan dengan os mandibula & os hyoideus dengan
perantaraan otot
Saraf, pembuluh darah dan & otot-otot extrinsik lingua
keluar masuk melalui radix lingua, yg tidak mempunyai
lapisan mucosa
Pada facies inf or lidah, dilinea mediana terdapat
frenulum Linguae (lipatan mucosa yang menghubungkan
facies inf or Linguae dengan dasar mulut)
- Lateral dari frenulum dibawah selaput lendir terlihat Vena
Profunda Lingua
- Dilateral vena terdapat plica fimbriata (lipatan selaput
lendir yang tepinya berumbai-umbai)

Perdarahan Lidah :
A. lingualis cabang A. Carotis
Eksterna
Cabang-cabang
Rr. Linguae
A. Profunda Lingua
Pembuluh darah balik :
V. Lingualis menerima darah
dari Vv.Dorsalis Lingua
V. Profunda Lingua yang
bersatu dengan V. Sublingualis
membentuk V. Commitans
V. Facialis

Pengaliran Lymphe :
-

Penting, karena sebagai jalan

penyebar kanker
Cairan Lymphe dari lidah
Nn.Ll.
Submentales, Nn Ll Submandibularis,
Nn Ll Cervicalis Prof
Pengaliran Lymphe ini mempunyai
hubungan kolateral

Persyarafan Lidah

2/3 bagian depan mendapatkan

inervasi dari N. Lingualis (Cabang NV3)
untuk somatosensorik, dan N Chorda
Tympani (cabang N VII) untuk rasa
kecap
1/3 bagian post & vallecula epigloticae
dari R. Lingualis N IX
Epiglotis oleh R. Laryngicus Int N X
Persarafan somatosensorik maupun
rasa kecap

Major glands

Parotid: so-called watery serous saliva

rich in amylase, proline-rich proteins

Submandibular gland: more mucinous

Stensons duct
Whartons duct

Sublingual: viscous saliva

ducts of Rivinus; duct of Bartholin

Kelenjar ludah

36

GLANDULA PAROTIS

DUCTOS PaROTIDeUS STENSON VESTIBULUM ORIS

80% : below the level of the external auditory canal, between

the mandible and the SCM.
Superficial to the posterior aspect of the masseter mm
CN VII branches roughly divide the Parotid G into superficial
and deep lobes while coursing anteriorly from the
stylomastoid foramen to the muscles of facial expression
Extensions of PG project to mastoid process
Down the anterior aspect of the SCM for a short distance
Around the posterior border of the mandible.
Superiorly to the to inferior margin of the zygomatic arch

Anatomy: Deep Lobe

Remaining 20% extends medially through the stylomandibular tunnel,

which is formed
ventrally by the posterior edge of the ramus
dorsally by the anterior border of the SCM & posterior digastric muscle
deeply and dorsally by the stylomandibular ligament.
Small ducts coalesce at the anterosuperior aspect of the PG to form
Stensens duct.
Runs anteriorly from the gland and lies superficial to the masseter muscle
Follows a line from the Ext Audit Meatus to a point just above the
commissure.
Is inferior to the transverse facial artery
It is 1-3 mm in diameter
6cm in length

Anatomy: Parotid Duct

At the anterior edge of the masseter muscle,

Stensens duct turns sharply medial and passes
through the buccinator muscle, buccal mucosa
and into the oral cavity opposite the maxillary
second molar.
Gland encapsulated by a fascial layer that is
continuous w/the deep cervical fascia (DCF).
The stylomandibular ligament (portion of the
DCF) separates the parotid and submandibular
gland.

Anatomy: Parotid
Lymphatics

Lymphatic drainage is to the

superficial and deep cervical nodes
Preauricular lymph nodes (LN) in the
superficial fascia drain the temporal
scalp, upper face, anterior pinna
LN within the gland drain the parotid
gland, nasopharynx, palate, middle
ear and external auditory meatus

2. GLANDULA
SUBMANDIBULARIS

DUCTUS SUBMANDIBULARIS
WHARTONI CAVUM ORIS
PROPRIUS (PAPILLA
SUBLINGUALIS )
Whartons duct passes
forward along the superior
surface of the mylohyoid
adjacent to the lingual
nerve.
The nerve winds around the
duct, first being lateral,
then inferior, and finally
medial.
Submandibular gland
drains into submandibular
nodes.

Anatomy:Submandibular
gland

Located in the submandibular

triangle of the neck, inferior &
lateral to mylohyoid muscle.
The posterior-superior portion of
the gland curves up around the
posterior border of the mylohyoid
and gives rise to Whartons duct.

3. GLANDULA
SUBLINGUALIS

DUCTULI
SUBLINGUALIS
CAVUM ORIS
PROPRIUS ( PLICA
SUBLINGUALIS )
Lie on the superior
surface of the
mylohyoid muscle
and are separated
from the oral
cavity by a thin
layer of mucosa.

Anatomy:
Submandibular duct

The ducts of the sublingual glands

are called Bartholins ducts.
In most cases, Bartholins ducts
consists of 8-20 smaller ducts of
Rivinus. These ducts are short and
small in diameter.
2-4mm in diameter & about 5cm in
length.
It opens into the floor of the mouth
thru a punctum.
The punctum is a constricted
portion of the duct to limit
retrograde flow of bacteria-laden
oral fluids.

Kelenjar-kelenjar sekitar mulut

Sifat : Tubulo Alveoler

Menghasilkan sekret mucous & serous

I. Gld Protis
- letak di fossa retro mandibularis caudal auricula
- Ductus Excretoriusnya bermuara dalam Vestibulum
Oris setinggi MII atas

II. Gld Sublingualis

- Gld Sublingualis Minor terletak lateral dari ductus
sub
mandibularis muaranya pada :Plica Sublingualis
- Gl. Sublingualis Major terletak pada ujung frontal
ductus sub mandibularis
muara pada Carancula Lingualis

III. Gl. Submandibularis

- Terletak dalam Trigonum
Submandibulare
- Muara pada Plica Lingualis
IV. Gl. Lingualis
- Gl. Lingualis Ant
terletak cranial dari dataran caudal apex
linguae. Muara pada Carancula medial dari
plica fimbriata
- Gl. Lingualis Post
letak : Caudal dari sulcus terminalis

DENS

Gigi

Dua set

Primer :
desidua, susu :
Kanak-kanak
Permanen/sekun
der: Dewasa (32)

Tipe

Incisivum,
canina, premolar
dan molar

4/4:2/2:4/4:
6/6

51

NOMENKLATUR GIGI / CARA MENULIS

GIGI GELIGI
Yang sering digunakan oleh dokter gigi adalah:
Menurut Zsigmondy.
Rahang atas dan rahang bawah dibagi menurut
garis horizontal, sedangkan kanan dan kiri
menurut garis vertikal
Gigi tetap:
87654321
12345678
87654321
12345678
misal: P2 atas kanan : 5
I1 bawah kiri : 1
Gigi sulung :
V IV III II I
I II III IV V
V IV III II I
I II III IV V
Misal : c bawah kanan : III
m2 atas kiri :
V

Menurut International Dental Federation / WHO.

Menggunakan 2 angka.
Angka pertama : menunjukkan kwadrant.
1 sampai 4 menunjukkan gigi tetap.
5 sampai 8 menunjukkan gigi sulung.
Angka diberikan sesuai arah jarum jam dari sisi kanan.
Angka kedua : menunjukkan gigi yang di dalam kwadrant.

Gigi tetap :
18 17 16 15 14 13 12 11
21 22 23 24 25
26 27 28
48 47 46 45 44 43 42 41
31 32 33 34 35 36
37 38
Misal : P2 atas kanan : 15
I1 bawah kiri : 31.
Gigi sulung :
55 54 53 52 51
61 62 63 64 65
85 84 83 82 81
71 72 73 74 75
Misal: c bawah kanan : 83
m2 atas kiri
: 65

Mm. Masticatoric

Otot
Pengunyah

4 otot besar,
muncul dari
kranium dan
masuk ke
mandibula
Temporalis &
Masseter
menaikkan
mandibula
M. pterigoideus
medial & lateral
bantu
menaikkan &
gerakan
mengayun
rahang bawah
ke arah lateral.

Esophagus

25 cm
Menembus diafragma
( hiatus esophagei) setinggi VTH 9-10
Dibagi 3 pars
1. PaRS CERVICALIS
2. PARS THORACALIS
3. PARS ABDOMINALIS
V : r. Esophagei a. Gastrica sinistra dan cab. A.
Phrenica inferior
Vena ke v. Azygos dan vena gastrica sinistra
I : r. Ant et post n. X
Simpatis ; n. splangnikus

58

PHARYNX
1.

2.

3.

NASOPHARYNX

CHOANE CAVUM NASI

TUBA AUDITIVA CAVUM TYMPANI

ISTHMUS PHARYNGICA
OROPHARYNX
OROPHARYNX

ISTHMUS FAUCIUM CAVUM ORIS

ISTHMUS FAUCIUM DIBATASI :

PALATUM

ARCUS PALATOGLOSSUS

LINGUA

DIANTARA ARCUS PALATOGLOSSUS

DAN PALATOPHARYNX TERDAPAT
SINUS TONSILARIS, BERISI
AMANDEL ( TONSILA PALATINA )
LARYNGOPHARYNX

CARTILAGO CRICOID
ESOPHAGUS

ADITUS LARYNGIS LARYNX

ESOPHAGUS
1.

2.
3.

3.

3.

PARS CERVICALIS
Berjalan dileher, antara vertebra
cervicalis 6/cartilago cricoid sampai
masuk cavum thorax melalui apertura
thoracis superior.
Berjalan diantara trachea di anterior
dan vertebra cervicalis di posterior
PARS THORACALIS
Terbesar
Berjalan di mediastinum posterior,
antara apertura thoracis superior dan
hiatus esophagicus
Diantara pericardium fibrosa di anterior
dan vertebra thoracalis di dorsal
PARS ABDOMINALIS
Impressio esophagei hepatis
Masuk ke lambung di belakang costa 7 kiri
Panjangnya 1,25 cm, berjalan di
dalam cavum abdomen, diantara
hiatus esophagicus sampa hubungan
nya dengan bagian gaster : cardia
Ostium cardiacum/cardiac
orifisium/junctio gastroesophagei
Sphinchter physiologica
Mengatur passage makanan dari
esophagus ke gaster
mencegah reflux chymus dari gaster
ke esophagus

Ventriculus

Ventrikulus
Regio hipokondriaka kiri,
epigastrica dan umbilikalis
CURVATURA MINOR
MELEKAT : OMENTUM MINUS

CURVATURA MAJOR
OMENTUM MAJUS

PERMUKAAN DALAM TERDAPAT LIPATAN

MUKOSA : RUGAE GASTRICA, YANG
KEARAH CURVATURA MINOR
MEMBENTUK :
PLICA LONGITUDINALIS GASTRICI
BAGIAN -BAGIANNYA :
1.

CARDIA
OSTIUM CARDIACA

2.
3.
4.

FUNDUS
CORPUS
PYLORUS
OSTIUM PYLORICA

SPHINCTER PYLORI

Incisura cardiaca :
sudut tajam fund
us dan pars
abdominalis
esophagei
Incisura angularis :
Sudut antara corpus
dan pars pylorika
pada kurvatura
minor
Pars pylorica : kanalis
pyloricum dan
anthrum phyloricum
Ruang semilunaris
Traube :
atas :garis dari costa 6 ke
pinggir bawah costa 9
pada LMC, bawah pada
arcus costarum
medial : pinggir kiri sternum

Intraperitoneal

duplikatur peritoneum viscerale dupermukaan anterior dan

posterior
Kurvatura minor ke arah hepar membentuk lig.
Hepatogastrica (bag omentum minus)
Ke bawah pada rhub dengan omentum gastrolienalis dan
mesocolon transtuk omentum mayus

Blood Supply

The rich arterial supply

of the stomach arises
from the celiac trunk and
its branches
Most blood is supplied by
anastomoses formed
along the lesser
curvature by the right
and left gastric
arteries, and along the
greater curvature by the
right and left gastroomental
(gastroepiploic)
arteries.
The fundus and upper
body receive blood from
the short and posterior
gastric arteries.
The veins of the stomach
parallel the arteries in
position and course

Gastric Innervation

Receives
Parasympathetic
innervations from
medulla via vagus nerves
Receives Sympathetic
innervations from celiac
ganglia arising from T5
T9

Lymphatic Drainage

mainly to the gastric

lymph nodes,
pancreaticosplenic lymph
nodes, pyloric lymph
nodes and pancreaticoduodenal lymph nodes
then drainage
accompany the large
arteries to the celiac
lymph nodes

ABDOMINAL VISCERA

1.
2.
3.
4.
5.
6.
7.

DUODENUM: fixed part

JEJUNUM & ILEUM: movable part (with
mesentery)
SURFACE ANATOMY
RELATIONS
PERITONEAL COVERING
BLOOD SUPPLY
NERVE SUPPLY
LYMPHATIC DRAINAGE
SUPPORT (IN SOME PARTS)

DUODENUM

Dari fleksura
duodenojejunalis
jejenum
25 cm, huruf C, kelilingi
caput pankreas
Dibagi 4, pars superior,
desenden, pars
inferior/horizontalis, pars
asenden
Pars superior : masih
diliputi peritoneum, 5
cm, setinggi L1,
bergerak paling bebas,
Ro : bulbus duodeni

Pars desenden : 8cm, ke bawah

setinggi Vl1-3 depan hilus
renalis, leksura
dudodenojejunalis
retroperiteal, bermuara ampula
Vateri, tempat papila duodeni
Mayor, spingter Oddi. 2 cm
diatasnya muara ductus panc
assesorius, papila duodeni
minor Santorini
Pars inferior : 8 cm, setinggi
VL3
Pars asenden : 5 cm, kekiri
setinggi VL2 beralih mjd
fleksura dudodenojejunalis
setinggi VL 2, ditahan lig Treitz
(m. susp. duodeni)

Duodenum
E : foregut, midgut
Vask :
1. Proksimal : cab. a. seliaka
(a. Pancreticoduodenalis
sup cab a.
Gastroduodenalis
2. Distal : a. mesenterika
superior (a.
Pancreticoduodenalis inf)
3. a. Gatrica dextra : pars sup
4. Cab. A. gastroduodenale

Vena : vena
mesenterica superior
>> v. Porta hepatika
V prepilorica ; vena
berjalan di depan
pylorus (batas
menentukan batas
pylorus dg duodenum)
I : PS : NX
S : pleksus sekitar a.
pancreaticoduodenalis

70

JEJUNUM
&
ILEUM
Length: 6 meters (20 feet)
Beginning: duodenojejunal flexure
Termination: ileocecal junction
Embryological origin: midgut
Peritoneal fold: mesentery of small intestine
Arterial supply: jejunal & ileal branches of
superior mesenteric
Lymphatic drainage: superior mesenteric lymph
nodes
Nerve supply: superior mesenteric plexus:
sympathetic & parasympathetic (vagus)

1.
2.
3.
4.
5.

MESENTERY OF SMALL
INTESTINE
Extent:
from duodenojejunal flexure to

ileocecal junction
Formation: formed of 2 layers
Free border (6 meters long): encloses
jejunum & ileum
Root (6 inches long, J-shaped): crosses
superficial to the following structures:
Third part of duodenum
Abdominal aorta
Inferior vena cava
Right psoas major
Right ureter

MESENTERY OF SMALL
INTESTINE

Shape: Fan-shaped with undulations

1.
2.
3.
4.
5.

Shape:
Content of root: superior mesenteric
vessels
Contents (structures between its 2 layers):
Jejunal vessels: form few arcades
Ileal vessels: form many arcades
Mesenteric lymph nodes
Autonomic nerve fibers
Mesenteric fat

MESENTERY OF SMALL INTESTINE

JEJUNUM
1.
2.
3.
4.
5.
6.
7.

Length: shorter (proximal 2/5)

Diameter: wider
Wall: thicker (more numerous plicae
circulares: circular folds of mucosa)
Appearance: more red in color (more
vascular)
Vessels: less arcades, long terminal
branches
Mesenteric fat: small amount near
intestinal border
Aggregations of lymphoid tissue: few

ILEUM
1.
2.
3.
4.
5.
6.
7.

Length: longer (distal 3/5)

Diameter: narrower
Wall: thinner (less numerous plicae
circulares: circular folds of mucosa)
Appearance: light red in color (less
vascular)
Vessels: more arcades, short terminal
branches
Mesenteric fat: large amount near
intestinal border
Aggregations of lymphoid tissue:
numerous (Peyers patches)

Beda jejenum & Ileum

Jejenum :
1. Otot polos > tebal
2. Diameter > besar
3. Plica sirkularis >besar,
>banyak, >rapat
4. Arcade a. Jejunalis
hanya 1 atau 2 tingkat
5. Vasa recta lbh panjang
6. Plaques payeri tidak
khas

Ileum
1. Otot polos > tipis
2. Diameter > kecil
3. Plica sirkularis
longgar
4. Arcade a. Jejunalis
bersusun2 dan
kompleks
5. Vasa recta > pendek
6. Plaques payeri khas

V/I Jejenum dan Ileum

Vask :
15-18 a. Jejunalis dan ilei -cab. Mesenterica superior
masuk ke mesenterium
membentuk arcade
Terminal ileum : cab akhir a.
Mesenterica superior
Vena : vena mesenterica
superior, bersatu dg vena
lienalis vena porta
hepatika

I:
P. S : NX
S : n.
mukosaSplangnikus
mayor dan minor
Mengikuti arteri
Masuk ke pl. My. Auerbach
: antara tunika
muskularis l dan M
Pl. Submuk Meissner di
tunika sub

81

INTESTINUM CRASSUM TERDIRI DARI

1. APPENDIX
MESOAPPENDIX (MESENTERIOLUM)
Pangkalnya melekat di caecum pada
pertemuan tiga tenia coli
2. CAECUM : intraperitoneal
3. COLON ASCENDENS : extraperitoneal
4. COLON TRANSVERSUM
diantara flexura coli dextra dan sinistra
Difiksasi oleh :MESOCOLONTRANSVERSUM
intraperitoneal

5. COLON DESCENDENS : extraperitoneal

6. COLON SIGMOID
intraperitoneal

difiksasi oleh: MESOCOLON SIGMOID

depo faeces

7. RECTUM

LARGE INTESTINE

CHARACTERISTICS:
1.
2.

3.

4.
5.
6.
7.

Teniae coli: thickening 3 longitudinal muscle bands

Haustra coli : pengantongan: teniae coli are shorter than
large intestine
Appendices epiploicae/omentales: short visceral peritoneal
fold/pouch filled with fat, kec di app, caecum dan rectum
Terfiksasi (col. As et des)
Diameter lebih besar, kontraksi lebih kuat
Mesenterium hanya pada col trans et sigmoid
Warna agak kelabu, usus kecil merah
N.B.: characteristics are present in all large intestine EXCEPT:
in rectum & anal canal

RECTUM
2 BAGIAN :
1. PARS SACRALIS/AMPULLARIS
RECTI
berisi feces / tekanan kepala bayi
(partus) mengejan.
normal ( reflex defekasi - )
kosong
2. PARS ANALIS
Terdapat :

SPHINCTER ANI INTERNUS, otonom

SPHINCTER ANI EXTERNUS
somatic dipengaruhi kemauan

PLICA TRANSVERSALIS RECTI

RANGSANGAN PARS AMPULLARIS
RECTI REFLEX DEFECATIO

Cecum

Blind pouch below the entrance of the

ileum
Almost entirely invested in peritoneum
Mobility limited by small mesocecum
Ileum enters posteromedially

Angulation maintained by superior and

inferior ileocecal ligaments

Three pericecal recesses or fossae

Superior, inferior, retrocecal

CECUM, ASCENDING &

DESCENDING COLON

1.
2.
3.

ANTERIOR RELATIONS:
Coils of small intestine
Greater omentum
Anterior abdominal wall

CECUM, ASCENDING &

DESCENDING COLON

POSTERIOR RELATIONS:
Cecum: psoas major, genitofemoral
nerve, iliacus, lateral cutaneous nerve of
thigh, femoral nerve
Ascending colon: iliacus, lateral
cutaneous nerve of thigh, quadratus
lumborum, ilioinguial nerve,
iliohypogastric nerve, iliac crest, origin
of transversus abdominis from lumbar
fascia
Descending colon: relations of cecum +
relations of ascending colon + left kidney

Ileocecal valve

Valve de Bauhin
Ileocecal sphincter

Slight thickening of muscular layer of

terminal ileum
Relaxes in response to food in the stomach

Competence

Regulates ileal emptying

Angulation plays a role in prevention of
reflux

Appendix
Vermiform appendix
Surface anatomy: the base of appendix is marked by McBurneys
point:
point A point at the junction of lateral 1/3 & medial 2/3 of a line
traced from right anterior superior iliac spine to umbilicus
Opening: at posteromedial aspect of cecum, 1 inch below ileocecal junction
Elongated diverticulum from posteromedial cecum about 3.0 cm
below ileocecal junction
Mean length 8-10cm, approx 5 mm diameter
Mesoappendix contains vessels
85-95% posteromedial toward ileum
Also can be retrocecal, pelvic, subcecal, pre-ileal, and retroileal

APPENDIX
Positions: (from
most to least
common)
1. Retrocecal:
Retrocecal most
common position
2. Pelvic
3. Subcecal
4. Preilieal
5. Postileal

Ascending colon

15 cm long, from ileocecal junction to right

colic or hepatic flexure
Retroperitoneal

Jacksons membrane

Covered anteriorly and on both sides, not

posteriorly
Adhesions between right abd wall and anterior
colon

Hepatic flexure supported by nephrocolic

ligament

Transverse colon

45 cm long
Intraperitoneal
Greater omentum fused on
anterosuperior aspect
Splenic flexure angle attached to
diaphragm by phrenocolic ligament

More acute, higher, and more deeply

situated than hepatic flexure

RELATIONS OF
TRANSVERSE COLON

ANTERIOR: greater omentum,

anterior abdominal wall
POSTERIOR: 2nd part of
duodenum, head of pancreas,
coils of small intestine
SUPERIOR: liver, gall bladder,
stomach
INFERIOR: coils of small intestine

Descending colon

25 cm
Retroperitoneal
Narrower and more dorsally situated
than ascending colon

Sigmoid colon

35-40 cm long
Mobile, omega shaped loop
Intraperitoneal
Mesosigmoid attached to pelvic walls in
inverted V, resting in intersigmoid fossa

Left ureter immediately below, crossed

anteriorly by spermatic, left colic and
sigmoid vessels

Rectosigmoid junction

Last 5-8 cm of sigmoid and upper 5

cm of rectum
Tinea libera and tinea omentalis fuse
and where haustra and mesocolon
terminate

6-7 cm below sacral promontory

Narrowest portion of large intestine

Functional sphincter

Blood supply

Superior mesenteric artery (midgut)

Supplies cecum, appendix, ascending colon,
proximal 2/3 of transverse colon
Middle, right and ileocolic branches
Inferior mesenteric artery (hindgut)
Supplies distal 1/3 of transverse, descending,
sigmoid
Left colic and 2-6 sigmoidal arteries
Becomes superior hemorrhoidal after crosses
left common iliac

Venous drainage follows arterial supply

Vessels and Nerves of the

Distal half of large
Large Intestine intestine

First half of large

intestine
Arterial supply superior mesenteric
artery
Innervation
Sympathetic
innervation
superior mesenteric
and celiac ganglia
Parasympathetic
innervation vagus
nerve

Arterial supply inferior mesenteric

artery
Innervation

Sympathetic
innervation
inferior mesenteric
and hypogastric
plexuses
Parasympathetic
innervation pelvic
splanchnic nerves

INTESTINUM CRASSUM

1.

2.

Lymphatic drainage:
Midgut: superior mesenteric lymph
nodes
Hindgut: inferior mesenteric lymph
nodes

Arteri Perut dan Pelvis

Veins Perut dan Pelvis

Rectum & Anal canal

Rectum

In pelvis
No teniae
Strong longitudinal
muscle layer
Has valves

Anal canal

Pectinate line*

Hemorrhoids (enlarged
veins)

Inferior to it: sensitive

to pain
Superior to pectinate
line: internal
Inferior to pectinate
line: external

*
*

Sphincters (close
opening)

Internal*

smooth muscle
involuntary

External*

skeletal muscle
voluntary
104

Location and peritoneal

relations of the rectum

S3
12
cm
1 inch infront
of coccyx

Shape (flexures) of the

rectum
- Anteroposterior curve
- 3 flexures
1.
2.
3.

Upper concave to left

lower concave to left
Middle concave to right

Rectal ampulla

Per rectal (PR) examination

Knee-chest position

Index finger introduced into

lower rectum through anal
orifice

Structures palpated

1.

Anterior

2.

Posterior

3.

On each side

Blood
supply of
rectum

Arterial supply
of the rectum
and anal canal

median sacral artery

superior rectal artery

(inferior mesenteric)
middle rectal artery
(internal iliac)
inferior rectal artery
(internal pudendal)

Veins of the rectum

Lymph drainage of rectum:

1.

2.

Upper half drains to para

rectal L.Ns which drain to
inferior mesenteric L.Ns.
Lower half drains to
internal iliac lymph nodes.

Anal canal
Beginning: It begins one inch below and anterior to the tip of the
coccyx at the recto-anal junction.

Course: It runs down and backwards.

Termination: It ends at the anus.

Relations:
Laterally: Ischioanal fossae.
Posteriorly: Anococcygeal raphe between it and tip of coccyx.
Anteriorly: Perineal body between it and bulb of penis in males.
Perineal body between it and vagina in females.

Blood supply, nerve supply and lymph drainage of anal canal:

Upper part

Lower part

Blood
supply

-It is supplied by superior rectal

artery.
- It is drained by superior rectal vein
(portal circulation).

-It is supplied by:

1- Middle rectal artery of internal iliac
artery.
2.Inferior rectal artery of internal pudendal
artery.
-The corresponding veins drain into internal
iliac vein (systemic circulation.)

Nerve
supply

Above pectinate line by autonomic

nerve fibers.

Below pectinate line by inferior rectal nerve

(Sensitive to pain &touch).

Lymphatic
drainage

Above pectinate line into internal

iliac LNs.

Below the pectinate line into superficial

inguinal LNs.

anal sinus
anal val

Pectinate
line
(dentate
line)

Anal
sphincters:
Internal anal sphincter:
-It is the thickened inner involuntary circular muscle layer of the anal canal.
-Surrounds the upper 3/4th of the anal canal, extending from ano-rectal junction till the
white line (Hiltons line).
Nerve supply: autonomic
External anal sphincter:
-Striated voluntary muscle fibers.
-Surrounds the whole length of the anal canal outside the internal anal sphincter.
-Parts: I) Subcutaneous Part:
-Surrounds the anus just under the perianal skin.
-Attached to perineal body &anococcygeal raphe.
II) Superficial Part:
-Surrounds the lower part of the internal sphincter above the subcutaneous part.
III) Deep Part

Relations of the Anal Canal

The anal canal is related:

posteriorly to the fibrous tissue
between it and the coccyx
(anococcygeal body),
laterally to the ischiorectal fossae
containing fat,
anteriorly to the perineal body
separating it from the bulb
of the urethra in the male or the lower
vagina in the female.

anal sinus
anal val

Pectinate
line
(dentate
line)

Sphincters of the anal canal

The external sphincter

(voluntary)

Vessels and nerves of the anal canal

2 cm
1 cm
cm

Organ Assesoris

123

HEPAR

124

organ kelenjar terbesar

Female 1200 1400 gr
Male
1400 - 1800 gr
Organ Intraperitoneal
Dibungkus kapsula fibrous capsula Glisson

sekat : lobulus hepatis

LOKASI :
- Regio hypochondriaca dextra
- Regio epigastrica
ANATOMI PERMUKAAN :
1. Facies diaphragmatica
- Concave ~ halus & bentuk kubah
Tertutup peritoneum, kecuali : bare area
of the
liver (pars affixa hepatis) melekat
diaphragma
Facies anterior, superior dan posterior
2. Facies visceralis ( postero inferior )

FASCIA VISCERALIS

Tertutup peritoneum, kecuali pars affixa hepatis

Impressio :

Gaster

Duodenum

Vesica fellea fossa vesica fellea

Flexura coli dextra

Ren dan glandula suprarenalis dextra

Omentum minus , tdd 2 bagian :

Lig. Hepatogastrica

Lig . hepatoduodenalis, membungkus portal triad

Terdapat celah fissura sagitalis & horizontalis
Fissura sagitalis , ada 2 :

Dextra, ditempati : vesica fellea & vena cava

inferior

Sinistra , ditempati oleh ligamentum teres hepatis

& ligamentum hepatogastrica ( bagian dari
omentum minus )
Fissura horizontalis :
Terdapat porta hepatis ( lubang tempat struktur
keluar
masuk : V. Porta, A. Hepatica, ductus hepaticus
/Portal
Triad ). Portal triad dibungkus oleh ligamentum
hepatoduodenalis ( bagian dariomentum minus )

struktur penghubung :
Ligamentum falciforme hepatis :
Duplicatur peritoneum yang
menghubungkan
facies diaphragmatis hepatis dengan
diaphragma & dinding ventral abdomen,
tepi
inferiornya ditempati oleh ligamentum
teres
hepatis yang berhubungan dengan
umbilicus
Omentum minus :
Duplikatur peritoneum yang
menghubungkan facies visceralis hepatis
dengan gaster ( sebagai ligamentum
hepatogastrica ) dan duodenum ( sebagai
ligamentum hepato duodenalis )

Parasagittal section
through liver
Showing subphrenic
recess and
hepatorenal recess

(Rutherford-Morison pouch)

Liver
Surfaces of Liver
1.
2.

Fasies Diaphragmatic
Fasies visceralis: structures lie like H

Liver
Visceral surface H
Cross-bar of H = Porta hepatis

1.

2.

3.

4.
5.

Hepatic artery, Portal vein, Bile ducts, Nerves and

Lymphatic vss.

Lt. superior of H = Ligamentum teres hepatis or

round ligament of liver (Remnant of umbilical v.)
Lt. inferior of H = Ligamentum venosum
(Remnant of ductus venosus)
Rt. superior of H = Gall bladder
Rt. inferior of H = Inferior vena cava

Visceral
Surface

Visceral
Surface

Liver
Peritoneal relations
1.

2.

Peritoneal ligaments

Lesser omentum

Falciform ligament

Coronary ligaments

Triangular ligaments
Vascular ligaments

Round ligament of the liver

Ligamentum venosum

Liver
Bare areas of the
liver
1.

2.
3.
4.

5.

6.

b/t Ant. & Post.

Coronary ligaments
Fossa for gall bladder
Porta hepatis
Fissure for round
ligament
Fissure for ligamentum
venosum
Fossa for IVC

Terdiri dari :

LOBULASI :

1. LOBUS DEXTRA
2. LOBUS SINISTRA
Antara lobus dextra dan sinistra dibatasi,pada :
1. Faciec diaphragmatica : ligamentum falciforme
2. Facies visceralis : fissura sagitalis sinistra

3. LOBUS CENTRALIS
Pada facies visceralis dibatasi oleh ;
Fissura sagitalis dextra, sinistra dan horizontalis

LOBUS CAUDATUS

LOBUS QUADRATUS

Functional lobes

Functional lobes

Liver
Blood supply of liver
1.
Rt. & Lt. hepatic arteries carry
oxygenated blood (25%)
2.
Portal vein carries venous blood
(75%) rich in nutrients
3.
Hepatic veins drain venous blood
to IVC

Hepatic Portal System

Portal venous system

A system of venous
blood vessels from
GI tract to the liver

Formation :

Superior mesenteric vein

+ Splenic vein (behind
neck of pancreas)

Portal venous system

Tributaries
1.
2.
3.
4.
5.
6.

Cystic vein
Paraumbilical vein
Right gastric vein
Left gastric vein
Splenic vein
Superior
mesenteric vein

Liver
Anterior vagal trunk

Autonomic nerves

Symp : Celiac plexus

Parasymp : Ant. and
Post. Vagal trunks

Celiac plexus

Liver
Lymphatic drainage of liver
Liver is a major lymphproducing organ
(1/4 -1/2 of lymph Thoracic
duct)

Diaphragmatic surface of
liver drains to Phrenic nodes
Visceral surface and deep
lymphatics along portal
triads drains to Porta
Hepatis Hepatic nodes
Coeliac nodes Cisterna
chyli Thoracic duct

Lymphatic
drainage of GI
tract

PANCREAS

RETROPERITONEAL,kecuali bagian :
CAUDA INTRAPERITONEAL

BAGIAN :

CAPUT
PROCESSUS UNCINATUS

CORPUS
FACIES
ANT., POST.. INF.
MARGO
SUP., ANT.,INF.
pada margo superior terdapat
tonjolan yang menempel pada
omentum minus, disebut :
TUBER OMENTALE
CAUDA

Pancreas

Gland with both

exocrine and
endocrine functions
15-25 cm long
60-100 g
Location: retroperitoneum, 2nd
lumbar vertebral level
Extends in an oblique,
transverse position
Parts of pancreas:
head, neck, body and
tail

Caput Pancreas

Prosesus uncinatus : penonjolan atas

dan kiri di belakang vena mesnterica
superior dan depan aorta
Flattened structure, 2 3 cm thick
Attached to the 2nd and 3rd portions of
duodenum on the right
Emerges into neck on the left

Collum Pancreas

2.5 cm in length
Antero-superior surface supports the
pylorus
Lekukan tempat vena mesenterica
superior (SMV) pada pars inferior
Posteriorly, SMV and splenic vein
confluence to form portal vein
Posteriorly, mostly no branches to
pancreas

Corpus Pancreas

Seperti prisma segitiga (fas. ant, post, inf)

Elongated, long structure
Anterior surface, separated from stomach by
omentum minus
Posterior surface, related to aorta, lt. adrenal
gland, lt. renal vessels and upper 1/3 rd of lt. kidney
V.lienalis (Splenica)melekat erat pada post. Surface
Inferior surface sempit, ditutupi transverse
mesocolon

Cauda Pancreas

Narrow, short segment, ujung kiri

Lies at the level of the 12th thoracic vertebra
Ujung dekat hilus splenika, berhub erat dg a/v
reanlis
Berada diantara kedua lig.
Splenophrenic/phrenicolienalis/splenorenalis/lien
orenalis
Anteriorly, related to splenic flexure of colon
May be injured during splenectomy (fistula)

Pancreatic Duct

Main duct (Wirsung) runs the entire length of

pancreas
Joins duktus choledocktus (CD) at the ampulla
of Vater
2 4 mm in diameter, 20 secondary branches
Ductal pressure is 15 30 mm Hg (vs. 7 17 in
CD) thus preventing damage to panc. duct
Lesser duct (Santorini) drains superior portion
of head and empties separately into 2nd portion
of duodenum

Arterial Supply of Pancreas

Variety of major arterial sources (celiac,

SMA and splenic)
Celiac Common Hepatic Artery
Gastroduodenal Artery Superior
pancreaticoduodenal artery which
divides into anterior and posterior
branches
SMA Inferior pancreaticoduodenal
artery which divides into anterior and
posterior branches

Arterial Supply of Pancreas

Anterior collateral arcade between

anterosuperior and anteroinferior PDA
Posterior collateral arcade between
posterosuperior and posteroinferior PDA
Body and tail supplied by splenic artery by
about 10 branches
Three biggest branches are

Dorsal pancreatic artery

Pancreatica Magna (midportion of body)
Caudal pancreatic artery (tail)

Pancreatic Arterial Supply

Arterial supply and venous drainage of the

pancreas and spleen

Recall blood flow, arterial

1)HEAD: Superior pancreatcoduodenal (A&P) arteries, from the
gastroduodenal of the common hepatic of the CELIAC
2)HEAD: Inferior pancreaticoduodenal (A&P) arteries from the SMA
3)BODY and TAIL: SPLENIC

Venous Drainage of
Pancreas

Follows arterial supply

Anterior and posterior arcades drain
head and the body
Splenic vein drains the body and tail
Major drainage areas are

Suprapancreatic PV
Retropancreatic PV
Splenic vein
Infrapancreatic SMV

Ultimately, into portal vein

Venous Drainage of the Pancreas

Lymphatic Drainage

Rich periacinar network that drain

into 5 nodal groups

Superior nodes
Anterior nodes
Inferior nodes
Posterior PD nodes
Splenic nodes

Innervation of Pancreas
Sympathetic fibers from the splanchnic
nerves
Parasympathetic fibers from the vagus
Both give rise to intrapancreatic periacinar
plexuses
Parasympathetic fibers stimulate both
exocrine and endocrine secretion
Sympathetic fibers have a predominantly
inhibitory effect

Gallbladder & Biliary tracts

Biliary system consists of
1. Gall bladder
2. Biliary tracts
Cystic duct, hepatic
ducts, common hepatic
duct and common bile
duct

I. Introduction/General
Information
A. Location:
1. Epigastric region
2. Right hypochondriac region
3. On inferior surface of liver
4. Between quadrate and right
lobes
B. Pear-shaped, hollow structure

Gallbladder
Location Epigastric region
and Right hypochondriac
region
Length 6-10 mm.
Capacity ~ 45 cm3
b/t Rt. lobe & Quadrate lobe of
liver
Surface projection
Fundus of gallbladder =
Murphys point

Gallbladder
Gallbladder has 4 portions
1.
Fundus
2.
Body
3.
Neck Infundibulum :
Hartmanns pouch
Internal surface :
folds, spiral
folds and crypts of
Luschka

Spiral valve

Neck
Body

Fundus

Hartmanns
pouch

Crypts
of
Luschka

Hartmanns Pouch.

Kantong antara Collum vesica fellea dengan ductus sisticus :

menentukjan foramen epiploica
A normal variation
May obscure cystic duct

Hartmanns Pouch
of the
Gallbladder
Cystic Artery
Branches

Gastroduodenal A.

Gallbladder
Blood supply of gallbladder
1.

Gallbladder

Cystic artery from

Right Hepatic artery

Cystic artery

(in Calots triangle

anatomic space
bordered by the common hepatic duct medially, the
cystic duct laterally and the cystic artery superiorly
lymph node located within the triangle,
Mascagni's lymph node or Lund's node. The latter is frequently
enlarged due to inflammation of the gallbladder (e.g.
cholecystitis) or the biliary tract (e.g. cholangitis) and may be
removed along with the gallbladder during surgical treatment (
cholecystectomy )

2.

Cystic vein : tributary of

Portal vein

Calots triangle

Biliary tract
1.

2.

3.

Cystic duct : ~ 3 cm
: spiral valve of Heisteri
Common hepatic duct
: ~ 3-5 cm
: from Rt. & Lt. hepatic
ducts
Common bile duct
: ~ 7.5 cm
1+2 3

Biliary tract
Common bile duct has
4 parts

Supraduodenal
Retroduodenal
Infraduodenal
Intraduodenal

Common bile duct + Major pancreatic duct

Hepatopancreatic ampulla (Ampulla of Vater)

Opening is Greater duodenal papilla in 2nd
part of duodenum (surrounded by Sphincter of
Oddi)
Oddi

Arterial Supply to the Gallbladder

Cystic artery

Right hepatic artery

Proper hepatic artery
Common hepatic
artery

Biliary tract
Anterior vagal trunk

Nerves of Gallbladder
Symp : Celiac plexus
Parasymp : Ant. and
Post. vagal trunks

Celiac plexus

Biliary tract
Lymphatic drainage of Gallbladder

Drain to Hepatic nodes of cystic nodes

Celiac nodes

Terimakasih

174