CkGAN nIS1CLCG kLLA1ICNSnIS Ak1Lk VLIN INNLkVA1ICN

Lsophagus
Mucosa: non-keraLlnlzed
sLraLlfled squamous

Muscu|ar|s: upper 1/3
skeleLal muscle, lower 1/3
smooLh muscle, exLernal
longlLudlnal, lnner clrcular


osLerlor Lo Lrachea,
posLerlor/rlghL of aorLlc
arch, posLerlor Lo lefL
aLrlum

3 areas constr|ct|on:
-aorLlc arch
-lefL maln bronchus
-esophageal hlaLus
(Lhrough dlaphragm -
physlologlc sphlncLer)


1horac|c:
MulLlple branches of thorac|c aorta

Abdom|na|:
Left gastr|c artery
(branch of cellac Lrunk off
abdomlnal aorLa)
Left |nfer|or phren|c
(small conLrlbuLlon, br. off
abdomlnal aorLa)


1horac|c:
Azygos system
(hemlazygos, accessory
hemlazygos, azygos veln)
Intercosta| ve|ns

Abdom|na|:
Left gastr|c ve|n
(lnLo porLal veln ! hepaLlc
porLal sysLem)
Azygos system
(small porLlon dralns wlLh
Lhoraclc esophagus)

Lsophagea| var|ces:
AnasLomoses beLween
azygos sysLem and hepaLlc
porLal sysLem, can geL
engorged ln cases of porta|
hypertens|on, can bleed
excesslvely
arasympathet|c:
Anter|or]oster|or
Vaga| 1runks

Sympathet|c:
1horac|c Sympathet|c
1runk ! Greater
Sp|anchn|c Nerve

arasympaLheLlc and
SympaLheLlc LogeLher
form Lhe esophagea|
nerve p|exus on dlsLal
esophagus







Stomach

aln refers Lo
ep|gastr|c and
|eft
hypochondr|ac
reg|ons of body
(16-19 ls
eplgasLrlc
reglon, vlsceral
paln, dull and
poorly
locallzed)
Mucosa:
Slmple columnar wlLh
varylng glands
Card|ac - colled Lubular
mucus glands w/
scaLLered enLeroendocrlne
Gastr|c - sLralghL,
branched Lubular glands,
wlLh mucus, parleLal (PCl),
chlef (pepslnogen) and
enLeroendocrlne cells
y|or|c - colled Lubular
mucus glands w/ scaLLered
enLeroendocrlne cells
(deeper gasLrlc plLs Lhan
cardlac)

Muscu|ar|s:
-ouLer longlLudlnal
-mlddle clrcular
-lnnermosL obllque
Card|a|: surrounds cardlac
orlflce (esophageal [cL)

Iundus: superlor porLlon
relaLed Lo lefL dome of
dlaphragm

8ody: bulk of sLomach
bLwn fundus and pylorlc

y|or|c: wlder pylorlc
anLrum leadlng Lo canal,
opens up Lo duodenum aL
orlflce (pylorlc sphlncLer =
Lrue sphlncLer)

Anter|or: lefL lobe llver,
dlaphragm, anL. abd wall

oster|or: lesser sac
(omenLal bursa), pancreas
-LxLremely rlch arLerlal supply
-lrom ce||ac trunk
-AnasLomoses beLween Lwo gasLrlc
(lesser) and Lwo gasLro-omenLal
(greaLer curvaLure)

Left Gastr|c - br. of cellac, ascends
Lo cardla and along lesser curvaLure
Sp|en|c - off cellac, behlnd sLomach
Left Gastro-omenta| - off splenlc,
runs along greaLer curvaLure
Short Gastr|c Arter|es - dlsLal end
splenlc, supply fundus
Common nepat|c - off cellac,
forms proper hepaLlc and
gasLroduodenal
k|ght Gastr|c - off proper hepaLlc,
ascends lesser curvaLure
k|ght Gastro-omenta| - off
gasLroduodenal, ascends greaLer
curvaLure

arallels arLerles

k]L gastr|c ! porta| ve|n

Short gastr|c and |eft gastro-
omenta| ! sp|en|c ve|n

k|ght gastro-omenta| !
super|or mesenter|c ve|n

***Splenlc veln + superlor
mesenLerlc =
hepat|c porta| ve|n***
arasympathet|c:
Anter|or Vaga| 1runk
(lefL vagus)
oster|or Vaga| 1runk
(rlghL vagus)

-sLlmulaLes gasLrlc acld
secreLlon, perlsLalsls,
glandular secreLlon,
relaxaLlon pylorlc
sphlncLer, vasodllaLlon,
sLreLch sensaLlon
abdomlnal vlscera

Sympathet|c:
16-19, greater
sp|anchn|c nerve
(Lhrough ce||ac p|exus)

-opposlLe
parasympaLheLlc



Sma|| Intest|ne:
Duodenum
(MosL dlgesLlon
occurs here)

aln refers Lo
ep|gastr|c
reg|on
Mucosa:
Slmple columnar wlLh
CrypLs of Lleberkuhn, vllll,
lsolaLed lymphold folllcles

Submucosa:
Submucosal mucus glands
(8runner's glands - CnL?
duodenum)

Muscu|ar|s:
CuLer longlLudlnal, lnner
clrcular
-WldesL, shorLesL, mosL
flxed parL of Sl, forms C
around pancreas head

Super|or part (duodena|
cap]ampu||a): dlsLal Lo
pylorus of sLomach,
promlnenL ln x-rays

Descend|ng part: has blle
ducL and maln pancreaLlc
ducL ([oln Lo form
hepaLopancreaLlc ampulla)

nor|zonta| part: crosslng
posLerlor abd wall aL L3

Ascend|ng: emerges from
reLroperlLoneal space,
conLlnuous w/ [e[unum



rox|ma| to entry of b||e duct
(foregut):
Ce||ac 1runk

(! Common hepaLlc arLery !
gasLroduodenal arLery ! superlor
pancreaLlcoduodenal a.)

D|sta| to entry of b||e duct
(m|dgut):
Super|or Mesenter|c Artery

(lrom abdomlnal aorLa, br. !
lnferlor pancreaLlcoduodenal a.)
-arallels Lhe arLerles

-uralns lnLo Lhe
nepat|c orta| Ve|n
arasympathet|c:
Vagus Nerve

Sympathet|c:
1S-19, Ce||ac and
Super|or Mesenter|c
|exuses


Sma|| Intest|ne:
I|eum]Ie[unum
(MosL
absorpLlon
occurs here -
80 of fluld)

aln refers Lo
per|umb|||ca|
reg|on of
anter|or body
wall



Mucosa:
Slmple columnar wlLh
CrypLs of Lleberkuhn, vllll
and pllca clrcularls
(MCS1L? [e[unum),
lsolaLed lymphold folllcles
and aggregaLes called
eyer atch (lleum CnL?)

Muscu|ar|s:
CuLer longlLudlnal, lnner
clrcular (forms sphlncLer aL
lleocecal valve - prevenLs
reflux from colon Lo lleum,
l.e. bacLerla)

-erlLoneal, very long
sLrucLure (>22 feeL)

Ie[unum: flrsL parL posL-
duodenum, proxlmal 2/3
of comblned lengLh, ln
uLC

I|eum: dlsLal 3/3, ln 8LC,
smaller dlameLer and
fewer pllca clrcularls, [olns
colon aL lleocollc [cL,
enLers aL obllque angle







Lxc|us|ve|y from:
Super|or Mesenter|c Artery
(! [e[unal/lleal arcades)

1erm|na| ort|on:
I|eoco||c br.
(from superlor mesenLerlc a.)

-arallels Lhe arLerles

-unnamed velns draln lnLo
Super|or Mesenter|c Ve|n

-lleal br. of I|eoco||c Ve|n
dralns lnLo superlor
mesenLerlc veln also

arasympathet|c:
oster|or Vaga| 1runks
(causes lncreased
secreLlons and moLlllLy)

Sympathet|c:
(18)19-110(11)
(causes
vasoconsLrlcLlon,
conLracLlon of
sphlncLers, lnhlblLlon of
secreLlon and
perlsLalsls)










Large Intest|ne
(absorpLlon)

aln ls felL ln
hypogastr|c
reg|on


-Larger dlameLer, Lenlae
coll, has omenLal
appendlces (faLLy
pro[ecLlons on exLerlor
surface), sacculaLlons
called hausLra beLween
Lenlae coll

Mucosa:
Slmple columnar wlLh
CrypLs of Lleberkuhn
(nC vlLLl), lymphold
folllcles common, esp. ln
dlsLal colon/recLum, MAn?
lymphocyLes ln lamlna
proprla

Muscu|ar|s:
lnner clrcular wlLh 3 bands
of ouLer longlLudlnal
(Lenlae coll)


Cecum:
ln 8LC (lllac fossa),
covered ln perlLoneum and
moblle (nC mesenLery),
aLLaches Lo vermlform
appendlx (has shorL
mesenLery -
mesoappendlx)

Ascend|ng:
8lghL slde abd cavlLy, from
cecum Lo 8 lobe of llver,
ends aL rlghL collc flexure,
usually reLroperlLoneal
(23 have mesenLery)

1ransverse:
LargesL, mosL moblle,
suspended by Lransverse
mesocolon, exLends across
abd from rlghL collc flexure
Lo lefL collc flexure,
poslLlon varlable

Descend|ng:
uown lefL slde abd cavlLy
from lefL collc flexure Lo
lefL lllac fossa,
reLroperlLoneal (shorL
mesenLery - Lermlnal parL)

S|gmo|d:
ConLlnuous wlLh
descendlng, ends aL
recLum, S-shaped loop
suspended by slgmold
mesocolon






M|dgut unLll lefL collc flexure
n|ndgut dlsLal Lo lefL collc flexure

Super|or Mesenter|c Artery

Cecum: lleocollc arLery

Append|x: appendlcular arLery
(br. of lleocollc)

Ascend|ng and k|ght Co||c I|exure:
8lghL collc arLery

1ransverse: Mlddle collc arLery
(some rlghL and lefL collc)


Infer|or Mesenter|c Artery

Descend|ng: lefL collc arLery

S|gmo|d: slgmold arLerles

Marg|na| artery - formed by
exLenslve anasLomoses wlLhln Ll
arLerles

-arallels Lhe arLerles

-lleocollc, rlghL collc, mlddle
collc ! Super|or Mesenter|c
Ve|n

-LefL collc, slgmold !
Infer|or Mesenter|c Ve|n !
Splenlc veln

-All dralns lnLo hepat|c porta|
system (superlor mesenLerlc
+ splenlc = hepaLlc porLal
veln)

arasympathet|c:
unLll lefL collc flexure -
Vagus Nerve

ulsLal Lo lefL collc -
Sacra| arasympathet|c
I|bers

Sympathet|c:
unLll lefL collc flexure -
110-L1

ulsLal Lo lefL collc -
L1-2
(unLll recLum)








kectum and
Ana| Cana|

Mucosa:

8ecomes sLraLlfled
squamous (non-
keraLlnlzed ! keraLlnlzed
ln anal canal)

Muscu|ar|s:

lnLernal sphlncLer - more
proxlmal, smooLh muscle,
dlsLenslon of ampulla
causes relaxaLlon

LxLernal sphlncLer - more
dlsLal, skeleLal muscle, 3
zones: subcuLaneous,
superflclal and deep,
blends wlLh levaLor anl
muscle aL puborecta||s (all
lmporLanL ln fecal
conLlnence)

-llxed, mosLly
reLroperlLoneal, ln pelvlc
cavlLy, conLlnuous wlLh
slgmold colon aL S3

Sacra| f|exure: follows
curve of sacrum and
coccyx

Anorecta| f|exure: recLum
ends aL sharp angle, where
guL perforaLes pelvlc
dlaphragm (levaLor anl
muscle - where ana| cana|
beglns), lmporLanL for
fecal conLlnence

Latera| f|exures: superlor,
lnLermedlaLe, lnferlor -
due Lo lnfoldlngs on
lnLernal surface

Ampu||a: expanslon of
recLum dlsLal Lo lnferlor
recLal fold, holds fecal
maLLer, lmporLanL ln
conLlnence

Ana| Cana|: longlLudlnal
rldges called anal columns
(Lermlnal br. superlor
recLal arLery/veln),
LermlnaLe aL pecLlnaLe llne

kLC1UM:

Super|or recta| artery -
ConLlnuaLlon of lnferlor mesenLerlc
arLery

k|ght and |eft m|dd|e recta|
arter|es -
lrom lnLernal lllac arLerles

Infer|or recta| arter|es -
lrom lnLernal pudendal arLerles ln
pelvls

ANAL CANAL:
Super|or recta| artery -
Above pecLlnaLe llne, from lnferlor
mesenLerlc arLery

M|dd|e recta| artery

Infer|or recta| artery -
8elow pecLlnaLe llne

kLC1UM:

-8oLh porLal and sysLemlc
dralnage - lmporLanL slLe of
porta|-system|c
anastomoses

Super|or recta| ve|n !
lnferlor mesenLerlc veln !
hepaLlc porLal veln

M|dd|e and |nfer|or recta|
ve|ns ! sysLemlc velns

venous dralnage forms Lhe
Interna| and externa| recta|
venous p|exuses

ANAL CANAL:

Interna| and externa| venous
p|exuses
lnLernal hemorrholds from
prolapse around lnLernal
plexus, same wlLh exLernal

Super|or recta| ve|n (above
pecLlnaLe llne) ! lnferlor
mesenLerlc veln ! porLal
sysLem

Infer|or recta| ve|n (below
pecLlnaLe llne) ! caval
venous syLem (sysLemlc)

Lymph:
Above - lnLernal lllac lymph
nodes
8elow - superflclal lngulnal
lymph nodes



kLC1UM:

arasympathet|c -
S2-S4 e|v|c sp|anchn|c
nerves, |nfer|or
hypogastr|c p|exuses,
no longer vagal

Sympathet|c -
Lumbar splnal cord
(112]L1-2) vla |umbar
sp|anchn|c nerves,
hypogastr|c p|exus,
per|-arter|a| p|exus of
lnferlor mesenLerlc
arLery

ANAL CANAL:

arasympathet|c -
lnhlblLs lnLernal anal
sphlncLer

Sympathet|c -
ConLracLs lnLernal anal
sphlncLer

Above pect|nate -
vlsceral lnnervaLlon vla
|nfer|or hypogastr|c
p|exus

8e|ow pect|nate -
SomaLlc lnnervaLlon vla
|nfer|or recta| nerve









ancreas
Iunct|on:

Lndocr|ne -
lnsulln, glucagon,
somaLosLaLln

Lxocr|ne -
ulgesLlve enzymes, blcarb

Lxocrlne reach duodenum
vla ma|n pancreat|c duct
(Lall of pancreas) LhaL [olns
Lhe blle ducL Lo form Lhe
hepatopancreat|c ampu||a

Accessory pancreat|c duct
dralns unclnaLe process,
lnferlor head, opens lnLo
duodenum aL mlnor
duodenal papllla
(communlcaLes wlLh maln
ducL ln head of pancreas)

-8eLroperlLoneal

-nead (c-curve of
duodenum) Lo ta|| (lnLo
llenorenal llgamenL)

-Unc|nate process from
lnferlor parL of head
behlnd superlor
mesenLerlc arLery

-Neck ls consLrlcLed by
superlor mesenLerlc arLery
and veln

-8ody forms parL of
sLomach bed, conLacLs
aorLa, superlor mesenLerlc
arLery, lefL adrenal gland,
lefL kldney


Sp|en|c Artery -
lorms arcades wlLh pancreaLlc
branches of gastroduodena| a. and
super|or mesenter|c artery

8ody and ta|| - branches of splenlc

nead - super|or
pancreat|coduodena| a. and
|nfer|or pancreat|coduodena|

-arallels arLerlal supply
(slmllar Lo venous dralnage
duodenum)

-8ody and ta|| - dralned by
small velns empLylng lnLo
Sp|en|c Ve|n

arasympathet|c -
Vagus Nerve
Supplles aclnar cells,
may sLlmulaLe
secreLlon of pancreaLlc
enzymes

Sympathet|c -
1horac|c Sp|anchn|c
Nerves from 1S-19
lnnervaLe blood vessels
and aclnar cells and
lsleLs




L|ver

aln felL ln
ep|gastr|um
and refers Lo
shou|der

Iunct|on:
-largesL gland of Lhe body
-deLoxlfles lngesLed
maLerlals
-absorbs dlgesLed food
-sLorage of glycogen
-synLhesls blood proLelns
-mucosal lmmunlLy

***orta| ve|n, hepat|c
artery, hepat|c ducts
enLer/exlL llver on vlsceral
surface aL porta hepat|s

-8uC under Lhoraclc cage
and dlaphragm, deep Lo
rlbs 7-11, exLends across
mldllne Loward lefL nlpple

-lllls 8 hypochondrlum,
upper eplgasLrlum,
exLends lnLo L
hypochondrlum

V|scera| surface -
abdomlnal organs

D|aphragmat|c surface -
ulaphragm

Iour |obes - rlghL, lefL,
quadraLe, caudaLe


Ce||ac trunk ! common hepat|c
artery ! proper hepat|c artery !
k|ght and Left nepat|c Arter|es

8lood flow from boLh porta| ve|n
(70) and hepat|c artery (30) -
need arLery for oxygenaLed blood

L|ver s|nuso|ds (from hepaLlc
a. and porLal v.) ! nepat|c
Ve|ns ! draln lmmedlaLely
lnLo Infer|or Vena Cava

nepat|c Nerve |exus:

arasympathet|c -
lrom Vagus Nerve

Sympathet|c -
lrom 17-110
Sympathet|c I|bers

luncLlon unclear, no
apparenL effecL on blle
producLlon

Afferents -
SympaLheLlcs and
vlsceral/dlaphragmaLlc
perlLoneum by k|ght
hren|c Nerve


Ga|| 8|adder

aln can be
severe, rapld
onseL, refers Lo
r|ght s|de
thorac|c wa||
(kU) ln reglon
of 6-9
th
r|b and
can radlaLe Lo
|nfer|or ang|e of
scapu|a
Iunct|on:
SLores, concenLraLes,
secreLes blle, conLracLs Lo
expel blle lnLo duodenum
ln response Lo
cho|ecystok|n|n (Ckk)
secreLed by lnLesLlnal
mucosa

8lle canallcull (llver) !
8/L PepaLlc uucLs !
Common PepaLlc uucL
(Lhrough orLa PepaLls)

Common nepat|c Duct +
Cyst|c duct (from gall
bladder) =
Common 8||e Duct


-Small sac on vlsceral
surface of llver

-ConLacLs flrsL parL of
duodenum and Lransverse
colon

-Composed of - fundus,
body, neck, cyst|c duct,
sp|ra| va|ve

-MosL dlsLal - Lhlck muscle
sphlncLer (sp|ra| va|ve),
keeps blle ouL of
duodenum for sLorage



Cyst|c Artery -
Maln arLerlal supply, branch of
k|ght nepat|c Artery


Venous dra|nage -
lnLo subsLance of llver, [olns
wlLh branches of Lhe
orta| Ve|n


arasympathet|c -
Vagus Nerve

Sympathet|c -

Sp|anchn|c Nerves
(16-19) ! ce||ac p|exus



Sp|een

aln felL ln UL
and can radlaLe
Lo |eft shou|der

Iunct|on:
-Lymphold organ
funcLlonlng ln removlng
senescenL blood cells,
fllLerlng anLlgens, and
mounLlng lmmune
response


-LefL of sLomach, ln greaLer
omenLum, dlvldlng lL lnLo
gastro||ena| and ||enorena|
||gaments

-LlgamenLs, vessels, nerves
aLLach/enLer aL h||um
(longlLudlnal flssure on
vlsceral surface) Lo form
sp|en|c ped|c|e

-ulaphragmaLlc, gasLrlc,
renal and collc surfaces


Sp|en|c Artery -
-LargesL branch of ce||ac trunk,
LorLuous
-osLerlor Lo sLomach
-CfLen embedded ln superlor parL
of pancreas

Sp|en|c Ve|n -
unlLes wlLh Super|or
Mesenter|c Ve|n Lo form Lhe
nepat|c orta| Ve|n

arasympathet|c -
NCNL

Sympathet|c -
Ce||ac Gang||a, 16-19
-causes conLracLlon of
spleen, forces 88Cs lnLo
clrculaLlon, l.e. ln
hypoxlc sLaLes






Lsophagus:


Stomach:


Duodenum:



I|eum & Ie[unum:




Large Intest|ne:




kectum and Ana| Cana|:




ancreas:





L|ver:





Ga|| 8|adder:

Sp|een:








Iunct|ons of Abdom|na| Crgans:


Lymphat|c Dra|nage:
1. Stomach, Sma|| Intest|ne, Duodenum, ancreas -
Ce||ac and Super|or Mesenter|c Nodes ! C|sterna Ch|||
2. Large Intest|ne -
Super|or and Infer|or Mesenter|c Nodes
3. kectum -
Infer|or Mesenter|c, ararecta|, and Sacra| Nodes
4. Ana| Cana| -
Above pecLlnaLe llne - Interna| I||ac Lymph Nodes
8elow pecLlnaLe llne - Superf|c|a| Ingu|na| Lymph Nodes









orta|-System|c Anastomoses: lmporLanL ln porLal P1n, block of lvC
1. Gastroesophagea| reg|on
2. Anorecta| reg|on
3. araumb|||ca| reg|on
4. ketroper|tonea| reg|on