Anatomy-1 PDF

GIT
ANATOMY
SYLLABUS
Gross Anatomy: (p .7)
Regions and quadrants of abdomen, Umbilicus: Normal position, umbilical hernia
Oral cavity:(p .8)
Adult tooth: Dental Formula, Microscopic Structure, palate: Development, gross features, tongue:
Development, gross features, blood supply, Microscopic Structure, salivary glands: Development, Microscopic
Structure, gross features
Pharynx:(p .14)
Gross features, parts, relations, innervation.
Peritoneum and subdiaphragmatic spaces
Oesophagus:(p .21)
Extent, normal constrictions, blood supply, lymphatic drainage, microscopic structures
Stomach (p. 23) and Duodenum (p. 26):
Gross features, vasculature, relation, innervation, lymphatic drainage, microscopic structure, applied aspects.
Jejunum and ileum: (p .29)
Gross features, Regional differences, parts, blood supply, microscopic structure
Large intestine: (p .30)
Parts, cardinal features, Differences between small and large intestines, blood supply, nerve supply
Appendix, Caecum:(p . )
Position, gross features, applied anatomy, microscopic structures of appendix V
Colon :parts, gross features, nerve supply, Blood supply, lymphatic drainage
Pancreas:(p. 38)
Parts, position, relations, blood supply, lymphatic drainage, development, applied anatomy, microscopic
structures
Rectum and Anal Canal:(p .34)
Parts, gross features, nerve supply, blood supply, lymphatic drainage, applied anatomy
Anterior Abdominal Wall:(p. 43)
Flat Muscles
Rectus sheath:(p. 44)
Formation, boundaries and contents, Rectus abdominis, nerves, blood supply, rectus sheath.
Inguinal canal-Boundaries, contents in males and females, Inguinal hernias
Posterior Abdominal Wall: (p .47)
Muscles and fascia-thoracolumbar fascia
Abdominal aorta: (p. 48)
Extent and branches
Inferior venacava: (p. 48)
Formation and tributaries
Lumbar plexus: (p. 48)
Formation and branches
Cisterna chyli (p. 49)
FAST TRACK BASIC SCIENCE MBBS -5-

Anatomy
-6- FAST TRACK BASIC SCIENCE MBBS

GIT
ANATOMY
GROSS ANATOMY Embryological importance:

Regions and quadrants of Abdomen - Meeting point of:
• Four folds of embryonic plate (2 lateral
folds, head folds and tails folds)
• 3 systems:
1. GI-Vitellointestinal duct
2. Excretory→Urachus
3. Vascular - umbilical vessels
Applied Aspects:
1. Raspberry red tumor: or cherry red tumor
Remnant of Vitello intestinal duct may form a
tumor at umbilicus.
2. Fecal Fistula: Persistence of patent vitello
intestinal duct.
♦ Abdomen is divided into nine regions by four 3. Urinary fistula/urachal fistula: Persistance of
imaginary planes, two horizontal and two vertical. entire urachus.
♦ Transpyloric (L1) and Transtubercular plane (L5)→ 4. Urachal cyst, urachal sinus: Persistance of some
Horizontal planes part of urachus.
V
♦ Right lateral and left lateral → Vertical planes 5. Omphalocele or Exomphalos (Umbilical hernia):
(Passing through Mid clavicular line and Mid - Herniation of abdominal viscera through
inguinal point) enlarged umbilical ring.
♦ Regions are as shown in figure. - Viscera are covered by amnion.
Umbilicus - Due to failure of bowel to return to the body
♦ Normal scar in Anterior Abdominal wall formed by cavity from its physiological herniation during
remnants of the root of the umbilical cord. 6th to 10th week.
♦ Variable in position, lower in infants and person 6. Gastroschisis:
with pendulous abdomen. - Protrusion of Abdominal contents through body
♦ In healthy adult: Lies in Anterior median plane, at wall, directly into the Amniotic cavity.
the level of disc between L3 and L4. - Occurs lateral to umbilicus, usually on right.
Anatomical Importance: - Due to abnormal closure of body wall around
- Level of umbilicus is watershed (see special connecting static.
points for MCQs). - Viscera are not covered by peritoneum or
- Skin around it supplied by T10 segment of Amnion.
spinal cord. - Survival rate more than omphalocele.
- Site of portocaval anastomosis, forms caput - Not associated with chromosome abnormalities.
medusae in portal hypertension.

Anatomy
ORAL CAVITY - In man: Teeth replaced only once so called

Past Questions: Diphyodont.
- Dental formula for milk/deciduous teeth
1. Give an account on development of tongue.
2102
Mention its lymphatic drainage (4)[11 July] =2102
2. Mention the sensory and motor nerves supply of
2123
the tongue. Explain in brief the source of For adult/permanent= 2123
development in relation to the nerve supply.
(2+2=4) [10 July] - It represents number of tooth in each half of
each jaw in order – Incisor, canine, premolar
3. Name the extrinsic muscles of tongue. Mention
and molar.
their nerve supply. (3+1= 4) [09 Dec]
4. Name the extrinsic muscles of the tongue. - In milk teeth: 2 incisor, 1 canine, no premolar
Mention their actions and nerve supply. and 2 molars : Total = 20
(3+3+2) [05 June] - In permanent teeth: 2 incisor, 1 canine, 2
5. Describe the tongue under the following premolar and 3 molar in each half of each jaw.
headings: (2 + 2 = 4) [09 July] Total = 32
a. Sensory nerve supply Microscopic structure of adult tooth [07 July]
b. Lymphatic drainage
6. Give an account of the development of the
tongue, with reasons according to the sources of
nerve supply. (3 + 1 = 4) [05 Dec]
7. Name the extrinsic muscle of tongue. Give their
nerve supply. Which muscle is called the safety
V muscle and why? (2 + 1 + 1 = 4) [05 June]
8. a. Mention the sensory and motor nerve supply
of the tongue. (4) [04 Nov]
9. Write briefly about the tongue under the
following headings: (2 +2 = 4) [03 Nov]
a. Sources of the development
b. Nerve supply-sensory and motor.
10.Draw a neat labelled diagram to show the parts
of an adult tooth. Add a note on the dental
formula. (2 +2 = 4) [07 July]
11.Describe the parotid gland under the following
headings. (1+1+2=4)[08 Dec] - Each tooth has 3 parts:
a. Location
1. Crown
b. Structure present within the gland
2. Neck, surrounded by gum
c. Nerve supply
3. Root
Tooth - Structurally: (1) Pulp in centre (2) Dentine
Dental formulae [07 July] surrounding the pulp, (3) Enamel (4)
- Way of representing the number of different Cementum (5) Periodontal membrane
types of teeth.
GIT
1. Pulp: Contains vessels, nerve and ↓

lymphatics; enter the pulp through apical Which forms primary palate.
foramen. ↓
Covered by a layer of tall columnar cells Two shelf like outgrowths from maxillary prominence
called odontoblasts: From dentine. called palatine shelves
2. Dentine: Calcified material, No blood ↓
supply, No nerve supply.
Fuses and forms the secondary palate.
3. Enamel: Hardest substance in the body, No
blood supply, No nerve supply. Primary palate
(From intermaxillary segment)
4. Cementum: Resembles bone in structure,
No blood supply, No nerve supply.
5. Periodontal membrane: Acts as
periosteum.
Incisive foramen
Applied Aspects: Secondary palate
(From palatine shelves)
1. Scurvy:
– Gums swollen and spongy, bleed on touch. Hard palate
– Vit 'C' deficiency
2. Pyorrhoea alveolaris: Chronic pus discharge at
Gross features
margin of gums. - Its anterior two thirds are formed by palatine
process of maxilla and its posterior one third
3. Dental caries: Decalcification of enamel and
by horizontal plates of palatine bones.
dentine.
- Arteries: Greater palatine branch of maxillary V
4. Apical abscess: Infection of Apex of root creating
artery.
abscess.
- Venous drainage: Pterygoid plexus of veins.
5. Hutchinson's teeth: Notched teeth occuring in
congenital syphillis. - Nerve supply: Greater palatine and
nasopalatine branch of pterygopalatine
6. Natal teeth: Erupted by the time of birth.
ganglion.
7. Tetracyalines: Discolored tooth
- Clinical correlation: Partial or complete lack of
8. Rickets: Deficient in enamel.
fusion of maxillary prominence with the medial
Development: nasal prominence on one or both sides: Cleft
1. Enamel: Ectoderm palate.
2. Dentine, Pulp: Mesoderm Soft palate:
3. Cementum: Periodontal membrane Development
Palate - Epithelium from: Ectoderm of maxillary
Hard palate: process.
Development: - Muscles from: 1st, 4thand 6th branchial arches.
Two medial nasal prominences margining at deeper level - It is unossified posterior part of fused palatal
process. (Note: ossified part forms: Part of
↓
hard palate)
Forms intermaxillary segment

Anatomy
Gross features:
Muscles of soft palate:
Muscles Arrangement Nerve supply Actions
1. Tensor veli palatine - It is flattened tendon i.e. palatine - Mandibular nerve - Tightens soft palate
aponeurosis forms fibrous base of
soft palate
2. Muscular uvula - Near the median plane palatine - Pulls up uvula

aponeurosis splits enclose this
muscle
3. Levator veli palatine - Superior surface of palatine - Elevates soft plates

aponeurosis - Cranial part of accessory
- Opens auditory tube
nerve through vagus
4. Palatopharyngeus - Superior surface of palatine - Pulls up wall of
aponeurosis pharynx
5. Palatoglossus - Inferior surface of palatine - Pulls up root of

aponeurosis tongue
Note: - Epithelium:
a. Of anterior 2/3rd: From two lingual
- Levator veli palatini→ Closes pharyngeal isthmus.
swellings and tuberculum impair, which
- Palatoglossus→ Closes oropharyngeal isthmus. arises from first branchial arch, so it is
supplied by: lingual and chorda tympani.
V Blood Supply:
- Greater palatine branch of maxillary artery, b. Posterior 2/3rd: From hypobranchial
eminence, i.e. from 3rd brancial arch, so it is
ascending palatine branch of facial artery,
supplied by Glossopharyngeal nerve.
palatine branch of ascending pharyngeal
artery.
Congential anomaly:
- Ankyloglossia (Tongue tie)
- Venous drainage:
- Macroglossia
• To pterygoid and tonsilar plexus.
- Microglossia
Clinical correlation:
Gross feature:
- Paralysis of soft palate in vagus nerve lesions: Muscles of tongue:
• Produces nasal tone, fattening of palatal 1. Intrinsic muscles: Originate and terminate in the
arch. tongue itself and is responsible for changing the
Tongue shape of tongue.
Four on each side:
Development and relation to nerve supply
a. Superior longitudinal
(11 July, 05 Dec )
b. Inferior longitudinal
- Muscles of tongue: From occipital myotomes
c. Transverse
- Connective tissue: From local mesenchyme d. Vertical

GIT
2. Extrinsic muscles [05 June]

Extrinsic muscles of tongue
Muscle Origin Insertion Action
Pulls up the root of tongue,
Descends in the palatoglossal arch
Oral surface of approximates the palatoglossal
Palatoglossus to the side of tongue at the junction
palatine aponeurosis arches and thus closes the
of oral and pharyngeal parts
oropharyngeal isthmus
Whole length of
Side of tongue between styloglossus Depresses tongue, makes dorsum
greater cornua and
Hyoglossus and inferior longitudinal muscle of convex, retracts the protruded
lateral part of hyoid
tongue tongue
bone
Tip and part of
Pulls tongue upwards and back
Styloglossus anterior surface of Into the side of tongue
wards
styloid process
Retracts the tongue
Genioglossus (fan- Upper fibres into the tip of tongue Depresses the tongue
Upper genial tubercle
shaped bulky Middle fibres into the dorsum Pulls the posterior part of tongue
of mandible
muscle) Lower fibres into the hyoid bone forwards and protrude the tongue
forwards. It is a life saving muscle
Arterial supply: - Tip of the tongue:
- Lingual artery; branch of external carotid • Bilaterally to the submental nodes.
- Tonsilar branch of facial artery.
- Right and left halves of the remaining part of
- Ascending pharyngeal branch of external
carotid. the anterior two thirds of the tongue:
Venous drainage: • Unilaterally to the submandibular nodes.
- Lingual vein → Internal Jugular vein. - Posterior one-third of the tongue: V
Lymphatic drainage [9 July, 11 July] • Bilaterally to the jugulo-omohyoid nodes.
- Posterior most part:
• Bilaterally into the upper deep cervical
lymph nodes.
Nerve supply [10, 09, 09, 05, 04, 03]
- Motor nerves:
• All Intrinsic and extrinsic muscles except
palatoglossus supplied by hypoglossal
nerve.
• Palatoglossus supplied by: cranial root of
accessory nerve through pharyngeal plexus.
- Sensory nerves:
Sensory nerves by:
a. Lingual nerve
b. Glossopharyngeal nerve
c. Internal laryngeal branch of vagus

Anatomy
Parts of the tongue

Posterior most part of
Nerve supply Anterior two - thirds Posterior one-third
vallecula
Sensory Lingual (post-trematic Glossopharyngeal Internal laryngeal branch of
branch of 1st arch) vagus
Taste Chorda tympani except Glossopharyngeal including Internal laryngeal branch of
vallate papillae (pre- the vallate papillae vagus
trematic branch of 1st arch)
Development of epithelium Lingual swellings of I arch. Third arch which forms Fourth arch which forms
from endoderm Tuberculum impar which large ventral part of small dorsal part of
soon disappears hypobranchial eminence hypobrachial eminence
Applied Aspects: • Capsule and stroma from mesenchyme.
- Genioglossus: Life saving muscles. Note:
- Under surface of tongue: Site for observation of - Parotid: Largest
Jaundice. - Sublingual: Smallest salivary gland
- Carcinoma of tongue: Spread via lymphatics, - Submandibular and sub lingual glands:
carcinoma of posterior 1/3rd is more dangerous Endodermal in origin – from oral mucosa.
because of bilateral lymphatic spread. - Capsule and stroma from Mesenchyme
Salivary glands Gross features of parotid gland:
♦ 3 parts: Parotid, submandibular and lingual. - Resembles pyramid, 15g in wt.
Development: Location [08 Dec]
- Parotid gland [08 Dec] - Situated below external acoustic meatus.
• Ectodermal in origin. - Between ramus of mandible and
• From Buccal epithelium lateral to angle of sternocledomastoid.
V mouth. - Gland overlap these structures.
• Outgrowth branches repeatedly form duct - Capsule of parotid gland: formed by investing
system and acini. layer of deep cervical fascia.
Relations:

GIT
Structure within parotid gland [08 Dec]
V
Blood supply: ↓
- Arterial supply: External carotid artery and its Relay in otic ganglion
branches. ↓
- Venous drainage: External Jugular vein and Postganglionic fibres through auriculotemporal nerve
Internal Jugular vein. ↓
Nerve supply [08 Dec] Parotid gland
1. Para sympathetic nerves: are secretomotor 2. Sympathetic nerves
- Reach parotid through the Auriculotemparal - Vasomotor
nerve. - Derived from plexus around middle meningeal
artery.
Inferior salivatory nucleus
3. Sensory nerves: From auriculotemporal nerve.
↓
Note: Parotid fascia by sensory fibers of great
IX nerve
auricular nerve (C2, C3)
↓
Tympanic branch Applied Aspects:
↓ 1. Parotid swellings are very painful due to
unyielding nature of parotid fascia.
Tympanic plexus
2. Parotid abscess: Caused by spread of infection
↓ from opening of parotid duct in mouth cavity.
Lesser petrosal nerve Best drained by Hilton's method.

Anatomy
3. Malignant changes of mixed parotid tumor is ♦ Division: The interior of pharynx is divided into
indicated by: pain, rapid growth, fixity with three parts namely:
hardness, enlargement of cervical lymphnodes. i. Nasophanyx
4. Frey syndrome/Auriculotemporal syndrome ii. Oropharynx
occurs at times after parotidectomy. iii. Laryngo-pharynx
- Characterized by: Increased sweating in Relation
regions supplied by auriculotemporal nerve on
♦ Superiorly: supported by body of sphenoid and
chewing.
basilar part of occipital bone.
♦ Inferiorly: Oesophagus opposite the C6 vertebra.
PHARYNX ♦ Anteriorly:
Communicates with:
Past Questions:
- Nasal cavity through choanae
1. Name the boundaries of the tonsillar fossa and
- Oral cavity through oro-pharyngeal isthmus
mention the arterial supply of palatine tonsil.
- Larynx through laryngeal inlet.
(2) [04 Nov]
♦ Posteriorly
2. Mention the extent of pharynx and name its
- Supported by upper six cervical vertebrae with
subdivisions. Write in brief the important
intervertebral discs, pre & para-vertebral muscle.
features present in the interior of pharynx.
- Prevertebral fascia
(1 +3 = 4) [03 June]
- Retro-pharyngeal space and its contact.
3. Give an account of the interior of the pharynx. -
♦ On each sides:
Enumerate nerves supplying the inferior
V pharyngeal constrictor. (3 +1 = 4) [06 June] - Styloid process of temporal bone
- Styloid group of muscle
4. Mention shape, extent, length and
communications of pharynx (2+2+2+4) [08 Nov] - Carotid sheath
- Lateral lobe of thyroid gland
Definition ♦ Lateral wall of naso-pharynx communicates with
♦ The pharynx is a musculo–membranous tube tympanic cavity via the auditory tube.
which is lined internally by the mucous
Gross features of each part of pharynx
membrane.
1. Naso-pharynx (Epipharynx)
♦ It acts as a common channel for both deglutition
- Location: Behind nasal cavity and above the
and respiration, because the food and air passage,
soft plate.
cross each other in this region.
- Boundaries:
♦ Extent:
• Anterior wall: Deficient and communicates
If extends from the base of skull to level of 6th with nasal cavity via choanae
cervical vertebra there onwards, continued as • Roof and posterior wall: Form continuous
esophagus. surface that slopes downwards backward
♦ Situation: It is situated behind the nasal and oral supported by body of sphenoid, occipital
cavities and behind the larynx. bone (basilar part) and anterior arch of
atlas.

GIT
• Features: Roof and posterior wall → Extend between levator veil palatini
a. Naso-pharyngeal tonsil and longus capitis.
→ Formed by aggregation of lymphoid 2. Oro-pharynx (Mesopharynx)
tissue beneath the mucus membrane. - Location:
b. Pharyngeal bursa (Pouch of luschka) • Behind the oral cavity
→ It is mucus diverticulum extending → Supported dorsally by bodies of C2 and C3
upward into substance of naso- vertebrae and by content of retro-
pharyngeal tonsil. pharyngeal space.
c. Pharyngeal hypophysis - Communication:
→ Some cell of nasopharyngeal roof • Anteriorly with oral cavity through oro-
resembles histologically to pharyngeal isthmus.
adenohypophysis. • Inferiorly with laryngo pharynx at level of
→ Cells are derived from backward upper border of epiglottis.
extension of Rathke's pouch.
- Features:
• Floor
• Palatine tonsil lodged in tonsilar fossa.
a. Communicates with oro-pharynx via
pharyngeal isthmus. • The tonsil presents on lateral wall of
oropharynx on each side.
b. Bounded in front by posterior surface
and free margin of soft plate. 3. Laryngo-pharynx (Hypopharynx):
Behind by mucous elevation of - Extent:
passavant's ridge • From upper border of epiglottis to the V
c. On each side: palato-pharyngeal arch lower border of cricoid cartilage.
contain muscle palato-pharyngeus. - Support: Behind by
• Lateral wall: Features are:
• Bodies of C4 to C6 vertebrae
a. Pharyngeal opening of auditory tube
• Prevertebral fascia
→ It is situated 1.25cm behind and
slightly below the posterior end of • Retropharyngeal space
inferior nasal choncha. - Features:
b. Tubal elevation • Anterior wall of laryngo-pharynx presents
→ Guards the upper and posterior pharyngeal inlet.
margin of auditory opening. • Laryngeal inlet is bounded:
→ Acts as guide for the introduction of a → Above and infront: By upper margin of
catheter. epiglottis
→ Tubal tonsil overlies the elevation.
→ Below: Inter-arytenoids fold of mucus
c. Pharyngeal recess (Fossa of Rosenmuller) membrane.
→ It is a mucous covered deep • Lateral wall of laryngo-pharynx presents
depression behind the tubal pyriform fossa
elevation.

Anatomy
Comparison between nosopharynx, oropharynx and laryngopharynx

Particulars Nasopharynx Oropharynx Laryngopharynx
a. Situation Behind nose Behind oral cavity Behind larynx
b. Extent Base of skull (body of Soft palate to upper border Upper border of epiglottis to
sphenoid) to soft palate of epiglottis lower border of cricoid cartilage
c. Communications Anteriorly with nose I. Anteriorly with oral Inferiorly with oesophagus
cavity
II. Above with nasopharynx
III. Below with
laryngopharynx
d. Nerve supply Pharyngeal branches of IX and X nerves IX and X nerves
pterygopalatine ganglion
e. Relations: Posterior nasal aperture Oral cavity I. Inlet of larynx,
i. Anterior II. Posterior surface of cricoid
III. Arytenoid cartilage
ii. Posterior Body sphenoid bone Body of second and third Fourth and fifth cervical
cervical vertebrae vertebrae
iii. Lateral wall Opening of auditory tube Tonsillar fossa containing Piriform fossa
palatine tonsils
f. Lining epithelium Ciliated columnar epithelium Stratified squamous Stratified squamous
nonkeratinised epithelium nonkeratinised epithelium
V g. Function Passage for air (Respiratory Passage for air and food Passage for food
function)
Muscles of pharynx - But stylo-pharyngeus is supplied by the
- Muscular coat of pharynx are arranged in outer glossopharyngeal nerve.
circular layers and inner longitudinal layer. - In addition, inferior constrictor is supplied by
- Circular layer consists of recurrent laryngeal and external laryngeal
i. Superior constrictor muscle nerve.
ii. Middle constrictor muscle Sensory innervations:
iii. Inferior constrictor muscle i. Naso-pharynx: By pharyngeal branch of
- Longitudinal layer consist of 3 paired muscle pterygopalatine ganglion/converging fibres of
maxillary nerve.
i. Stylo-pharyngeus
ii. Oro-pharynx: By glossopharyngeal nerve.
ii. Palato–pharyngeus
iii. Laryngo-pharynx: By internal laryngeal nerve.
iii. Salpino-pharyngeus
Innervations of pharynx: Note: Pharyngeal plexus:
Motor innervations: Formed by pharyngeal branch of
- All pharyngeal muscles are supplied by the i. Vagus carrying fibres of accessory nerve
cranial part of accessory nerve via the ii. Glossophapyngeal nerve
pharyngeal plexus. iii. Superior cervical ganglion of sympathetic trunk.

GIT
- It is loosely attached to the walls by extra-

PERITONEUM peritoneal connective tissue.
Past Questions: - Developmentally, it is derived from somato-
1. Discuss the greater omentum under the pleuric layer of lateral plate mesoderm.
following heading: (1 + 1 + 1) [06 June] - Blood supply and nerve supply are the same as
a. Development those of overlying body wall.
b. Structures present within it - Because of somatic innervations, parietal
peritoneum is pain-sensitive.
c. Clinical importance V
2. Short notes on: ii. Visceral peritoneum
a. Epiploic foramen (2, 3)[07 July, 05 June] - It lines the outer surface of viscera to which it
is firmly adherent and cannot be stripped.
b. Lesser omentum (3) [3 June]
- Developmentally: it is derived from the
Definition
splanchno-pleuric layer of the lateral plate
♦ Peritoneum is a large serous membrane lining the mesoderm.
abdominal cavity. - Blood supply and nerve supply are the same as
♦ Histologicaly, it is composed of: those of underlying viscera.
i. Fibrous tissue (outer layer): provides strength • Because of autonomic innervation, visceral
ii. Mesothelial cells (inner layer): Secrete fluid. peritoneum evokes pain when viscera is
♦ Peritoneum is in form of closed sac which is stretched, ischemic or distended.
invaginated by number of vicera. Functions of peritoneum
♦ Division of peritoneum - Movements of viscera
i. Parietal peritoneum - Protection of viscera
ii. Visceral peritoneum →Suspends the viscera - Absorption and dialysis
i. Parietal peritoneum - Healing power and adhesion
- It lines inner surface of abdominal and pelvic - Storage of fat
wall and lower surface of the diaphragm.

Anatomy
Peritoneal folds
♦ The peritoneal folds are
1. Greater omentum
2. Lesser omentum
3. Mesoappendix
4. Transverse mesocolon
5. Sigmoid colon
6. Mesentery
1. Greater omentum [06]
Definition:
- The greater omentum is a large fold of
peritoneum
- It hangs down from the greater curvature of
the stomach like apron and covers the loops of
intestines to varying extent.
- It is made up of 4 layer of peritoneum fused 2. Lesser omentum (03)
together to form fenestrated membrane with Definition:
varying amount of fat, small arteries and veins. - This is a fold of peritoneum which extends
Attachment: from the lesser curvature of stomach and first
- The anterior 2 layers descend from the greater 2cm of the duodenum to the liver.
curvature of the stomach to a variable extent, Modification:
V which fold upon themselves to form the i. Hepato-gastric ligament: The portion of lesser
posterior two layers that ascend to the anterior omentum between stomach and liver.
surface of head and anterior border of the
ii. Hepato–duodenal ligament: The portion
body of the pancreas.
between duodenum and liver.
- The folding is such that 1st layer becomes 4th
Structures related to lesser omentum:
layer and 2nd layer becomes 3rd layer.
i. Lesser sac: Behind the lesser omentum
Content:
ii. Epiploic foramen: Behind the free right margin
i. The right and left gastroepiploic vessels and its
of lesser omentum.
anastomoses
Attachment:
ii. Fat
- Inferiorly, the lesser omentum is attached to
Functions:
the lesser curvature of the stomach and to the
i. It is a storehouse of fat upper border of first 2cm of duodenum.
ii. Provides protection against infection because - Superiorly: It is attached to the liver and line of
of presence of macrophages patches (milky attachment is "L" shaped.
spots).
- Vertical limb of "L" is attached to bottom of
iii. Limit the spread of infection by moving to site fissure for the ligamentum venosum.
of infection and sealing it off from the adjacent
- Horizontal limb of "L" to margin of porta-
area. So, greater omentum is called policeman
hepatis.
of the abdomen.

GIT
Content: Contents:
a. Hepatic artery proper a. Jejunal and ileal branches of superior
b. The portal vein mesenteric artery.
c. The bile duct b. Accompanying veins
c. Autonomic nerve plexuses
d. Lymph nodes and lymphatics
d. Lymphatics or lacteals
e. Hepatic plexus of nerves.
e. 100-200 lymph nodes
Along lesser curvature of stomach and along upper f. Connective tissue
border of adjoining part of duodenum contain
Epiploic foramen (07, 05)
i. The right gastric vessels
♦ Also known as
ii. The left gastric vessels - Foramen of Winslow
iii. The gastric group of lymph nodes and - Aditus
lymphatic's - Opening of lesser sac
iv. Braches from gastric nerve Definition:
3. Mesoappendix: - It is vertical slit like opening through which the
lesser sac communicates with the greater sac.
- It is small triangular fold of peritoneum which
suspends the vermiform appendix. Posterior Location:
Surface of lower end of mesentery is close to - Located behind the right free margin of lesser
omentum at level of 12th thoracic vertebra.
the ileocaecal junction.
Boundaries:
4. Transverse mesocolon: - Anteriorly: Right free margin of lesser
- Broad fold of peritoneum which suspends the omentum containing the portal vein, hepatic
transverse colon from upper part of the artery proper and common hepatic duct.
posterior abdominal wall. - Posteriorly: IVC, right suprarenal gland and T12 V
Content: vertebra.
- Inferiorly: 1st part of duodenum and the
- Middle colic vessel
horizontal part of hepatic artery.
- Nerves, lymph nodes - Superiorly: Caudate process of the liver.
- Lymphatics of transverse colon.
Applied Aspects:
5. Sigmoid mesocolon - Passage of internal hernia into lesser sac take
- This is a triangular fold of peritoneum which place via the aditus.
suspends the sigmoid colon from the pelvic
wall.
Content:
- Sigmoid vessel (in Lt. limb of inverted "V")
- Superior rectal vessel (in Rt. limb of inverted
"V")
- Lymph nodes and lymphatics
6. Mesentery
- It is broad, fan shaped fold of peritoneum
which suspends the coils of jejunum and ileum
from post abdominal wall.

Anatomy
Lesser Sac or omental bursa Boundaries:

♦ This is a large recess of the peritoneal cavity Anteriorly
behind the stomach, lesser omentum and caudate - Inferior surface of right lobe of liver.
lobe of liver. - Gall bladder
♦ Communication: It communicates with greater sac Posteriorly
via epiploic foramen. - Right suprarenal gland
Boundaries - Upper part of right kidney
Anterior walls is formed by: - Second part of duodenum
i. Caudate lobe of liver - Hepatic flexure of colon
ii. Lesser omentum - Transverse mesocolon
iii. The stomach - A part of head of pancreas
iv. Anterior two layer of greater omentum Superiorly
Posterior wall is formed by: - Inferior layer of coronary ligament
i. Posterior two layer of greater omentum Inferiorly
ii. Transverse mesocolon - Opens into general peritoneal cavity
iii. Duodenum Applied Aspects:
iv. Pancreas i. It is the most dependent part of abdominal cavity
Upper border is formed by: proper when body is supine.
i. Reflection of peritoneum to diaphragm from ii. Collection of fluids, pus
oesophagus. iii. Commonest sit of sub phrenic abscess caused by
ii. Upper end of fissure for the ligamentum spread of infection from organs in this region.
V venosum.
iii. Upper border of the caudate lobe of the liver.
Lower border is formed by:
i. Continuation of the 2nd with 3rd layers of
greater omentum
Sub division of lesser sac
i. Inferior recess
ii. Superior recess
iii. Splenic recess
Note: The portion of lesser sac behind lesser
omentum is known as vestibule of lesser sac.
Applied Aspects: Recto uterine pouch of Douglas

i. Pus collection ♦ This most dependent part of peritoneal cavity
ii. Internal hernia (Strangulated type) when body is upright in position.
Hepatorenal pouch (Morison's pouch) Boundaries
Anteriorly
♦ It is called as right subhepatic space.
- Uterus
♦ Location: Lies below right half of visceral surface
of liver. - Posterior fornix of vagina

GIT
Posteriorly Development:
- By rectum Peritoneal folds Source of developments
Inferiorly
i. Greater omentum Dorsal mesogastrium
- By recto-vaginal fold of peritoneum
(Greater part)
Clinical importance
ii. Lesser omentum Dorsal part of ventral
- Pus collection
mesogastrium
Note:
iii. Gastro-splenic Ventral part of dorsal
i. The pouch can be drained either via rectum or
ligament mesogastrium
posterior fornix of vagina.
ii. In supine position Hepatorenal pouch is most iv. Lineorenal ligament Dorsal part of dorsal
dependent part of pelvic cavity. mesogastrium
v. Gastro-phrenic Cranial most part of dorsal
Sub-diaphragmatic space
ligament mesogastrium.
♦ It is also called sub-phrenic space
vi. Mesentry (ileum and Dorsal mesentery
♦ Location: It is just below the diaphragm in relation
to the liver. jejunum)
mesoappendix,
Classification
transverse-
A. Intra-peritoneal spaces are
mesocolon, sigmoid
i. Left anterior space colon
ii. Left posterior space
iii. Right anterior space Note: The mesentries of duodenum, ascending colon,
iv. Right posterior space and rectum are lost during development.
B. Extra peritoneal spaces are Development of lesser sac:
i. Right extra-peritoneal space i. Superior recess is developed from right V
ii. Left extra-peritoneal space pneumoneteric recess.
iii. Midline extra-peritoneal space (= bare area of ii. Inferior recess is developed from the
liver) invagination of dorsal mesogastrium
Note: downwards.
i. Left posterior space is lesser sac.
ii. Midline extra-peritoneal space corresponds to OESOPHAGUS
bare area of the liver. Past Questions:
1. Constrictions of esophagus with vertebral levels
and causes. (2)[08 July]
Extent
- Thoracic part: From lower border of cricoid
cartilage (C6) to opening in diaphragm
(Esophageal hiatus T10)
- Abdominal part: From Esophageal hiatus up to
cardiac end of stomach (T11/7th costal cartilage
level)
- Length: 25cm, (1.25cm is abdominal part)
- Curvatures: Two, side to side curve and one
anteroposterior curvature.

Anatomy
Constrictions: 4 constrictions normally [08]

Distance from incisor in inches (1 inch =
Sites and Causes of constriction Vertebral level
2.5cm)
1. At its beginning C6 6 inches, (15cm)
2. Where it is crossed by Aortic arch T4 9 inches (22.5cm)
3. Where it is crossed by left bronchus T5 11 inches (27.5cm)
4. Where it pierces diaphragm T10 15 inches (37.5cm)
Blood supply and lymphatic drainage:
Cervical part Thoracic part Abdominal part
Arterial supply Inferior thyroid Esophageal branch of Esophageal branch of left gastric
artery Aorta
Venous Interior thyroid Azygous, Hemiazygous Left gastric vein (portal), Azygous vein (Systemic)
drainage vein vein Hence, site of portosystemic anastomosis
Lymphatic Deep cervical Posterior mediastinal Left gastric nodes
drainage lymph nodes lymph nodes
Development: - Lumen: Irregular
th
- At 4 week - Mucosa:
- Part of foregut caudal to pharyngeal gut.
• Stratified squamous non keratinized
- Congential anomaly:
• At lower end, abrupt transition to columnar
• Esophageal atresia: Tracheoesophageal fistula
lining.
V • Esophageal stenosis
• Lamina propria with few lymphocytes,
• Congenital hiatal hernia
lymphatic nodules.
Applied Aspects:
• Few tortuous mucus secreting glands near
- Esophageal varices: Occurs due to portal HTN upper and lower ends.
- Achalsia cardia: Can occur during chagas disease • Muscularis mucosa with few smooth
- Barrett's esophagus: Complication of GERD muscles.
Histological features: - Submucosa: Tubuloacinar mucus secreting
glands.
- Muscularis externa:
• Upper 1/3rd has skeletal muscle
• Middle 1/3rd has both skeletal and smooth
muscles
• Lower 1/3rd has only smooth muscle
- Serosa:
• In the abdominal part
• Rest have Adventitia

GIT
STOMACH These structures are:

Past Questions: 1. Diaphragm
1. Write briefly on the relations of posterior surface 2. Left kidney
of stomach. (2) [KU2013] 3. Left suprarenal gland
Gross features 4. Pancreas
♦ Location: Lies obliquely in upper & left part of abdomen 5. Transverse mesocolon
- Occupies epigastric, umbilical and left 6. Splenic fexure of colon
hypochondriac region
7. Splenic artery
External features:
Anterior relations:
- 2 orifices: Cardiac and pyloric
- 2 curvatures: Lesser and greater 1. Liver
- 2 surfaces: Anterior and posterior 2. Diaphragm
- 2 parts: Subdivided into four 3. Anterior abdominal wall
Blood supply
Arterial supply:
Arteries Branch of
Along 1. Left gastric Coeliac trunk
lesser artery
curvature 2. Right gastric Hepatic artery proper
artery
Along 1. Right gastro Gastroduodenal
greater epiploic
V
Parts:
curvature 2. Left Splenic
1. Cardiac part: Fundus, body
2. Pyloric part: Pyloric antrum, pyloric canal gastroeplpolic
Relations Fundus 1. 5-7 short Splenic artery
Posterior relations of stomach/stomach gastric arties
bed [KU 2013]

Anatomy
Venous drainage: Nerve supply

1. Portal vein ♦ Sympathetic nerves: T6 – T10
2. Superior mesenteric ♦ Parasympathetic nerves: Vagus nerve
3. Splenic vein
Development
Lymphatic drainage:
♦ Stomach appears as fusiform dilation of foregut
in the fourth week.
♦ Positional changes occurs by rotation around
longitudinal and an Anteroposterior axis.
♦ Stomach rotates clockwise 90° around its
longitudinal axis, causing its left side to face
anteriorly and right side to face posteriorly.
♦ Left vagus nerve, initially innervating left side of
stomach now innervates anterior wall and vice
versa.
♦ Original posterior wall grows faster than anterior,
forming greater and lesser curvatures.

GIT
Congenital anomaly: d. Nerve supply is more abundant, with large

- Pyloric stenosis ganglia.
Applied Aspects: e. Because of Gastric canal, it receives most of
1. Gastric ulcer – Most common on lesser curvature. insult from irritating drinks.
2. Gastric carcinoma – Most common on lesser f. Being shorter in length the wave of contraction
curvature. stays at particular point.
This is possibly due to following reasons: 3. Metastasis of gastric carcinoma can occur to left
supraclavicular lymph node called Troisier's sign.
a. Mucosa is not freely movable over muscular
coat. 4. Gastric pain is felt in epigastrium because the
stomach is supplied from same segment of spinal
b. Epithelium is comparatively thin.
cord which also supply the upper part of
c. Blood supply is less abundant and there are
abdominal wall.
fewer anastomosis.
Histological features
1. Mucosa: Simple columnar epithelium iii. Pyloric glands:

a. 3 types of glands: - In pyloric antrum and canal
i. Cardiac glands: Simple tubular glands, - Open into deep gastric pits
posses majority of mucus secreting cells,
- Coiled tubular
few parietal and zymogen cells.
- Mainly mucus secreting cells
ii. Fundic glands:
- Lie is fundus and body b. Lamina propria and Muscularis mucosa
- Simple tubular, open into shallow gastric pits 2. Submucosa: With auerbach's plexus, blood vessels
- 5 types of cells → Chief cells, parietal 3. Muscularis externa: Outer longitudinal, middle
cells, mucus cells, stem cells, entero circular and inner oblique layer.
endocrine cells.

Anatomy
SMALL INTESTINE ♦ 6m long

Past Questions: ♦ Extends from pylorus to ileocaecal junction
1. Mention the extent and relations of second part Duodenum:

of duodenum. Name the structures opening into ♦ 25cm long
it. Add a note on its development. ♦ 4 parts:
(2+1+1=4) [04 Nov] Length level
2. Describe the relations of the second part of First part – 2 inches L1
duodenum with diagrams. What is its correlation
Second part – inches L2
with the development of hepatobiliary system.
Third part – 4 inches L3
[2+1 = 3] (KU2013) Fourth part – 1 inch L2
Relation of various parts:
First part Second part [04 013] Third part Fourth part
Peritoneal - Proximal half is attached - Retroperitoneal, - Retroperitoneal, - Retroperitoneal,
relations: to lesser omentum fixed. anterior surface is covered with
above and greater - Anterior surface is covered with peritoneum only
omentum below. covered with peritoneum except anteriorly
- Distal half is covered peritoneum, except in median plane.
with peritoneum only near the middle.
anteriorly
Visceral relations:
Anterior - Quadrate lobe of liver - Right lobe of liver - Superior mesentric - Transverse colon
V - Gallbladder - Transverse colon vessels, - Transverse
- Root of transverse - Root of mesentry mesocolon
colon - Lesser sac
- Small intestine - Stomach
Posterior Gastroduodenal artery - Anterior surface of - Rt. Ureter - Lt. sympathetic
Bile duct right kidney - Rt. psoas major chain, Lt. psoas
- Right renal vessels - Rt. gonadial vessels major
- Right edge of - IVC, Abdominal - Lt. testicular
inferior venacava aorta vessels
- Rt. Psoas major - Inferior mesentric
vein
Medical - Head of the - Attachment of
relation – pancreas – upper part of root
- The bile duct of mesentery
Lateral - Right colic flexure - Left kidney, ureter
– –
relation
Superior Epiploic foramen Head of pancreas with Body of pancreas
–
relation uncinate process
Inferior Head and neck of pancreas – Coils of Jejunum –

GIT

Anatomy
- Venous drainage: Splenic, superior mesentric

and portal vein.
- Nerve supply:
• Sympathetic →T9– T10
• Parasympathetic → Vagus nerve
Development
- Duodenum develops from two sources
- Part proximal to opening of hepatopancreatic
duct: from foregut
- Since foregut is supplied by celiac artery and
the midgut is supplied by superior mesentric
artery duodenum is supplied by branches of
both arteries.
Relation of second part with development of
hepatobiliary system: [KU 2013]
Blood supply - At distal end of foregut (i.e. in second part),
Arterial supply: liver bud arises.
- Upto level of opening of hepatopancreatic duct - The rapidly proliferating cells penetrate
is supplied by superior pancreaticoduodenal, septum transversum.
below it: By inferior pancreaticoduodenal. - The connection between hepatic diverticulum
V - First part also receives from: and foregut (duodenum) narrows forming bile
1. Right Gastric artery duct.
2. Supraduodenal artery of wilkie - Small outgrowth is formed by the bile duct, this
3. Retroduodenal branches of gastro duodenal outgrowth gives rise to gallbladder and cystic
artery duct.
Applied Aspects:
- In skiagrams taken after giving a barium meal, the
first part of duodenum is seen as a triangular
shadow called duodenal cap.
- Annular pancreas can cause duodenal obstruction.
Microscopic structure:
1. Villi: Numerous and leaf like
2. Crypts of liberkhun and Goblet cells are
present in epithelium (Few in number)
3. Submucosa has numerous mucus glands called
Brunner's gland.
4. Serosa is incomplete.

GIT
JEJUNUM AND ILEUM 2. Describe the differences between the jejunum

and the ileum, both in macroscopic and
Past Questions:
microscopic features. (3 +3 = 6) [03 Nov]
1. Give in tabular form the differences between the
3. Differences between jenjunum and ileum (4) [8 July]
gross features and microscopic anatomy of
4. Meckel's diverticulum (2) [10 July] (2) [05 Dec]
jejunum and ileum. (3 + 3 = 6) [09 July]
5. Intestinal villi (2) [07 July]
Differences between Jejunum and ileum [09 July, 03 Nov]
Features Jejunum IIeum
1. Location Occupies upper and left parts of the Occupies lower and right parts of the
intestinal area intestinal area
2. Walls Thicker and more vascular Thinner and less vascular
3. Lumen Wider and often empty Narrower and often loaded
4. Mesentery a. Window present a. No windows

b. Fat less abundant b. Fat more abundant
c. Arterial arcades, 1 or 2 c. Arterial arcades, 3 or 6
d. Vasa recta longer and fewer d. Vasa recta shorter and more numerous
5. Circular mucosal folds Larger and more closely set Smaller and sparse
6. Villi Large, thick (leaf-like) and more abundant Shorter, thinner (finger-like) & less abundant V
7. Peyer's patches Absent Present
8. Solitary lymphatic Fewer More numerous

follicles
Microscopic structure
Jejunum Ileum
- Villi are taller and - Villi are shorter and

tongue shaped fewer
- Crypts of liberkuhn - Lymphatic follicles in
longer than duodenum lamina propria
- Globlet cells are more - Peyer's patches
- Peyer's patches absent formed By
collescence of
- Submucosa is thin
lymphatic nodules in
- Serosa is almost complete
lamina propria

Anatomy
Blood supply: - This rotation is counter clockwise, Aprox. 270°

- Is by Branches of superior mesenteric artery when complete.
and are drained by corresponding veins. - 90° during herniation and 180° during return to
Development: abdominal cavity.
- From midgut - Retraction of loops occurs during 10th week.
- Development of midgut is characterized by Congenital anomaly:
rapid elongation of the gut and its mesentery, 1. Omphalocele (Described earlier)
resulting in formation of the primary intestinal 2. Gastroschisis (Described earlier)
loop (Apex of loop via vitellointestinal duct
3. Gut rotation defects → Results in abnormal
V communicates with yolk sac)
positioning of portions of gut.
- The cephalic limb of loop develops into the
4. Meckel's Diverticulum [10 July]
distal part of the duodenum, the jejunum and
part of the ileum. Persistent proximal part of vitellointestinal
- The caudal limb of loop becomes lower portion duct (it normally disappears during 6th week of
of ileum, the cecum, the appendix, ascending intrauterine life)
colon and the proximal 2/3rd of the transverse a. Occurs in 2% subjects.
colon. b. Usually 2 inches long.
Physiological herniation/ Physiological umbilical c. Situated 2 feet proximal to ileocecal valve.
herination 5. Apple peel atresia: Atresia in proximal jejunum.
- Development of primary intestinal loop is
characterized by rapid elongation, particularly LARGE INTESTINE
of cephalic limb.
Past Questions:
- As a result of rapid growth and expansion of
1. Differences between large and small gut
liver, abdominal cavity temporarily becomes
smaller to contain the umbilical cord during the (2) [11, July]
sixth week of development (physiological 2. Positions of vermiform appendix (2)
umbilical herination) 3. Micro-anatomy of vermiform appendix with a
Rotation of midgut labelled diagram (3) [03 June]
- Primary intestinal loop rotates around an axis 4. Draw a labelled diagram showing micro anatomy
formed by the superior mesenteric artery. of vermiform appendix. [4](2013 KU PBQs)
GIT
Parts 2. Fixed except Appendix, transverse colon and

- Extends from ileocecal junction to anus. sigmoid colon
- 1.5m long 3. Taeniae coli present
- Caecum, Ascending colon, the transverse 4. Appendices epiploicae [Small bags of peritoneum
colon, the descending colon, the sigmoid colon, filled with fat, found over large intestine except:
rectum and anal canal, vermiform appendix. Caecum, Appendix, Rectum (@CAR)]
Cardinal features 5. Blood supply by marginal artery
1. Wider in callibre 6. Sacculated and puckered.
Differences between small intestine and large intestine [11 July]
Feature Small intestine Large intestine
1. Appendices epiploicae Absent Present
2. Taeniae coli Absent Present
3. Sacculation Absent Present
4. Distensibility Less More
5. Fixity Greater part is freely mobile Greater part is fixed
6. Villi Present Absent
7. Transverse mucosal folds Permanent Obliterated when longitudinal muscle coat relaxes
8. Peyer's patches Present in ileum Absent
9. Common site for a. Intestinal worms a. Entamoeba histolytica
b. Typhoid b. Dysentery organisms
c. Tuberculosis c. Carcinoma V
10.Effects of infection and irritation Diarrhoea Dysentery
Caecum
♦ Situated in right iliac fossa
♦ Above the lateral half of Inguinal ligament.
Dimension:
- 6cm long , 7.5cm broad
Note: Breadth > Length
Other organs whose b > l are:
i. Pons ii. Prostate iii. Pituitary
Relations:
- Anterior: Coils of intestine and anterior
abdominal wall.
- Posterior:
a. Muscles: Right psoas and Iliacus
b. Nerves: Genitofemoral, femoral and lateral Vermiform appendix
cutaneous nerve of thigh. (All of right side) ♦ Arising from posteromedial wall of caecum.
c. Vessels: Testicular or ovarian
♦ 2cm below ileocecal orifice.
d. Appendix in retrocecal recess.
♦ Length: 9cm (average)
Anatomy
Position [04 July] 3. Splenic 1. Upward to left

- Lies in Rt. iliac fossa. 2. Points toward spleen
- Base is fixed but tip direction is variable. 3. 2 o'clock position
4. Can be preileal or post ileal
Types of
Comments 4. Promontroic 1. Horizontally to left toward
appendix
sacral promontory
1. Paracolic 1. Pass upward to right 2. 3 o'clock position
2. 11 o'clock position 5. Pelvic 1. Second most common (30%)
2. Descending into pelvis
2. Retrocecal 1. Commonest position (65%) 3. 4 o'clock position
2. Lies behind caecum/colon 6. Subcecal or 1. Below caecum
mid inguinal 2. Point towards inguinal ligament
3. 12 o'clock position
3. 6 o'clock position
Parts of Large
Blood Supply Nerve Supply
Intestine
1. Caecum a. Cecal branch of Ileocolic Sympathetic: T11 – L1
b. Venous drainage into superior mesenteric vein Para-sympathetic: Vagus
2. Vermiform a. Appendicular branch of lower division of Sympath: T9–T10through celiac plexus
appendix Ileocolic artery Parasympth: Vagus
b. Venous drainage into appendicular, mesenteric
vein into portal vein
Lymphatic drainage
3. Colon a. Ileocolic, right colic & middle colic artery 1. Ascending colon: Epicolic and paracolic
(branches of superior mesenteric artery) & left colic Lymph nodes.
& sigmoid arteries (branches of inferior mesenteric 2. Transverse colon: Middle colic L.
artery) anastomose & forms marginal artery Nodes.
b. Vasarecta arises from marginal artery and 3. Descending colon and Sigmoid colon:
supply colon. Epicolic and paracolic lymph nodes.

GIT
Blood supply Ascending colon:

- Arterial supply: Appendicular artery which is a - Caudal limb of primary intestinal loop (i.e.
branch of the lower division of the ileocolic from mid gut)
artery. Transverse colon:
- Venous drainage: Blood from the appendix is - Proximal 2/3rd from caudal limb of primary
drained by the apendicular, ileocolic & superior intestinal loop. (i.e. from mid gut)
mesenteric veins, to the portal vein. - Distal 1/3rd from Hind gut.
V
Note: Appendicular orifice which situated on the Descending colon and sigmoid colon:
posteromedial aspect of the caecum 2cm below the - From Hindgut
ileocaecal orifice is guarded by an indistinct semilunar Microscopic Features of Appendix
fold of the mucous membrane, known as the valve of
[03 June, PBQ 2013 KU]
Gerlach.
Development
♦ Large intestine develops from both midgut and
Hindgut.
Caecum:
- From cecal bud (i.e. from midgut)
- As small conical dilation of caudal limb of
primary intestinal loop.
- Is last part of gut to reenter abdominal cavity
so lies in right side.
Appendix:
- Distal end of cecal bud form narrow diverticulum
called appendix. (i.e. from midgut)
- Since it develops during descent of colon. Its
final position is mostly Retrocecal.
Anatomy
1. Lumen small, Irregular outline. RECTUM AND ANAL CANAL

2. Villi absent. Past Questions:
3. Crypts of liberkuhn few.
1. Describe the rectum under the following
4. Epithelium is of columnar cells and few goblet
headings: (1+1+2+2=6) [08, July]
cells.
2. Short notes on rectum: (2 + 3 + 3 + 2) [05]
5. Lamina propria has lymphatic follicles
a. Extent with curvatures
6. Muscularis mucosa → Incomplete.
b. Posterior relations
7. Submucosa is thick with blood vessels and
nerves. c. Venous drainage
8. Muscularis externa→ Thin d. Peritoneal relations
9. Serous coat → Complete 3. Discuss anal canal under the following headings:
(4+1+1=6) [09, Dec]
Applied Aspects:
a. Interior
Caecum
1. Caecum is involved in: b. Arterial supply
i. Amoebiasis c. Sources of development
ii. Intestinal tuberculosis. 4. Interior of anal canal (2) [10, July]
iii. Carcinoma 5. Peritoneal relation of rectum (2) [11, July]

2. Inflammation of caecum is called a 6. Structures related anteriorly to the rectum in
caecitis/Typhilitis female (2) [05, Dec]
V Appendix
1. Inflammation of appendix is called appendicitis.
Rectum [05]
2. Removal of appendix is called appendectomy. ♦ Distal part of the large gut.
3. Pain is first felt in region of umbilicus; this is ♦ Between sigmoid colon above and anal canal
referred pain (because of innervations by same below.
spinal segment (T10) of the spinal cord) ♦ Curved in an anteroposteior direction and from
4. With increasing inflammation pain is felt in right side to side i.e. -It is not straight.
Iliac fossa. This is caused by involvement of ♦ Three cardinal features of large gut (sacculation,
parietal peritoneum. appendices epiploices and taeniae ) are absent.
5. MC Burney's point is site of maximum tenderness Gross features
in appendicitis.
Situation:
Colon
- In posterior part of lesser pelvis.
1. Congenital megacolon (Aganglionic megacolon or
- Infront of the lower three pieces of the sacrum
Hirschsprung disease):
and coccyx.
- Due to absence of parasympathetic ganglia in
Extent [05]
bowel wall.
- Begins as continuation of sigmoid colon at the
- These ganglia are derived from neural crest
level of third sacral vertebrae (S3).
cells.
[MCQ 2013 KU)

GIT
- Ends by becoming continuous with anal canal

at the anorectal junction.
- the anorectal junction lies 2 to 3 cm in front of
and a little below the tip of the coccyx .
Curves [05]
- The beginning and end of the rectum lies in the
median plane.
- However, it shows two types of curvatures in its
course:
1. Two anteroposterior curves:
- Sacral flexure
- Perineal flexure
2. Three lateral curves:
- Upper lateral curve
- Middle lateral curve
- Lower lateral curve Visceral
Males Females [05]
relations
Upper
Anterior - Upper 2/3rd - Upper 2/3rd
Sacral flexure Right relation related to related to
rectovesical rectouterine
pouch with coils pouch with coils V
Perineal flexure Lower Middle of intestine and of intestine and
Right Left
sigmoid colon. sigmoid colon.
Anal canal
- Lower 1/3rd to - Lower 1/3rd of
base of Urinary rectum is related
(a) (b) bladder, to lower part of
Curvatures of rectum terminal part of the vagina.
ureter, seminal
Relations vesicles, vas
Peritoneal relations: [05] deferens and
1. Upper 1/3 : rd prostate.
• Covered with peritoneum in front and on Posterior relation:
the sides. Same in male and female.
2. Middle 1/3rd: 1. Lower three pieces of the sacrum, the coccyx
• Covered only in front. and the anococccygeal ligament.
2. pyriformis, the coccygeus and the levator ani.
3. Lower 1/3rd:
3. The median sacral, the superior rectal and
• Devoid of peritoneum.
lower lateral sacral vessels.
4. The sympathetic chain with the ganglion impar.

Anatomy
Blood supply Anal canal [09]

Arterial supply: Situation:
1. Superior rectal artery: Continuation of inferior - Below level of the pelvic diaphragm.
mesenteric artery. - Lies in anal triangle of perineum in between
2. Middle rectal arteries. right and left ischioanal fossa.
3. Median sacral artery. Relations of anal canal:
Venous drainage: Both sex Males Females
V 1. Superior rectal vein pains into inferior mesenteric
1. Membranous
vein. Anteriorly Perineal 1. Lower end of
urethra
2. Middle rectal vein opens into internal iliac vein. body the vagina
2. Bulb of penis
3. Median sacral vein joins left common iliac vein.
Nerve supply: Posteriorly:
- Sympathetic: L1, L2 ⇒ Vasoconstrictor, inhibit 1. Anococcygeal ligament
rectal musculature and motor to internal 2. Tip of coccyx
sphincter. Laterally:
- Parasympathetic: S2, S3, S4 through superior - Ischioanal fossae
rectal or inferior mesentric and inferior
All round:
hypogastric plexus ⇒ motor to musculature of
- By sphincter muscles
rectum and inhibitory to the internal sphincter.
Interior of anal canal [10]
Note: Sensations of distension of rectum passes
through the parasympathetic nerves, while pain Divided into 3 parts:
sensations carried by both sympathetic and 1. Upper part:
parasympathetic nerves. - 15 mm long
Lymphatic drainage: - Lined by mucusmembrane, Endodermal origin.
1. Inferior mesenteric lymph nodes - 6–10 vertical folds called 'Anal columns of
2. Internal iliac lymph nodes morgagni'.

GIT
- Anal columns united at lower ends by anal valves.

- Depression in mucosa above each valve called
anal sinus.
- Line formed by anal valves together called
pectinate line.
2. Middle part/Transitional zone or pecten
- 15mm, lined by mucos membrane
- No anal columns
- Bluish appearance because of dense venous
plexus between mucosa and muscle coat.
- Lower limit has white line called white line of
Hilton.
3. Lower cutaneous part
- 8mm long, lined by true skin containing sweat
and sebaceous glands.
Note:
1. Conjoint longitudinal coat is formed by fusion of
puborectalis with longitudinal muscle coat of
rectum at anorectal junction.
2. Anorectal ring is formed by fusion of puborectalis
with uppermost fibers of external sphincter and
the internal sphincter.
Arterial supply Venous drainage Lymphatic drain V
age
- Above pectin 1. Internal rectal - Above
ate line by venous plexus pectinate line
superior in submucosa into internal
rectal artery of anal canal. iliac nodes
Musculatures of Anal canal - Below 2.External rectal - Below into
Anal sphincters: pectinate line venous plexus superficial
by inferior outside inguinal nodes
Internal anal sphincter:
rectal artery muscular coat
- Involuntary, circular muscle of rectum and
- Surrounds upper 3/4th of anal canal. anal canal;
- Ends at level of white line of hilton. communicates
with internal
External anal sphincter:
plexus.
- Voluntary 3. Anal veins
- Made of striated muscle
Nerve supply
- Surrounds whole length of anal canal.
1. Above the pectinate line
- 3 parts:
i. Subcutaneous - Supplied by autonomic nerves. Both sympathetic
(inferior hypogastric plexus: L1, L2) and
ii. Superficial
parasympathetic (pelvic splanchnic :S2, S3, S4)
iii. Deep

Anatomy
2. Belowpectinate line PANCREAS

- By somatic nerves.
Location:
- Inferior rectal: S2, S3, S4 - More or less transversely across the posterior
3. Sphincters: abdominal wall.
- Internal sphincter: - At the level of first & second lumbar vertebrae.
Sympathetic and parasymphathetic Parts:
↓ - From right to left:
Causes contraction and relaxation respectively - Head, Neck, Body, Tail
- External Sphincter: Inferior rectal nerve and Parts External features
perineal branch of S4.
Head - 3 borders: Superior, inferior & right lateral
Applied Aspects: - 2 surfaces: Anterior and posterior
Piles/Haemorrhoids: - 1 process: Uncinate process
i. Internal piles/True piles: Neck - 2 surfaces: Anterior and posterior
- Dilation of internal rectal venous plexus. Body - 3 borders: Anterior, superior, inferior
- Occur above pectinate line; painless. - 3 surfaces: Anterior, posterior, inferior
- Bleed profusely during straining.
Relations:
a. Primary piles:
Head of
in 3, 7 and 11 o'clock position Relations
pancreas
viewed on lithotomy position.
1. Superior - Overlapped by first part of
b. Secondary piles: In other position. border: duodenum.
V ii. External piles - Related to superior pancreaticoduodenal
- Occur below pectinate line artery
- Very painful, don't bleed. 2. Inferior - Third part of duodenum
Factors responsible for causing internal piles: border: - Inferior pancreaticoduodenal artery
1. Poor support to veins from surrounding connective 3. Right - Second part of duodenum
tissue. lateral - Terminal part of bile duct
border - Anastomosis between 2-
2. Absence of valves in superior rectal and portal
veins. pancreaticoduodenal arteries
3. Portal hypertension. 4. Anterior From above downwards:
4. Compression of veins at sites where they pierce surface: 1. First part of duodenum
muscular coat of rectum. 2. Transverse colon
2. Fissure in Ano: 3. Jejunum
- Rupture of one of anal valves. 5. Posterior 1. Inferior venacava
surface 2. Terminal part of renal veins
- Due to passage of dry, hard stools.
3. Right crus of diaphragm
3. Fistula in Ano:
4. Bile duct
- Track connecting two cavities.
6. Uncinate - Anteriorly to superior mesenteric vessels
- Due to spontaneous rupture of abscess around
process - Posteriorly to Aorta.
the anus.

GIT
Neck of Body of
Relations Relations
pancreas pancreas
1. Anterior - Attachment to root of transverse
1. Anterior 1. The peritoneum covering posterior
border mesocolon.
surface wall of lesser sac.
2. Superior - Coeliac trunk, Hepatic artery and
2. Pylorus
border splenic artery V
2. Posterior 1. Termination of sup. mesenteric 3. Inferior - Superior mesenteric vessels.
surface vein border
2. Begining of the portal vein. 4. Anterior - Related to lesser sac and to the
surface stomach
5. Posterior - Aorta with origin of sup.
surface mesenteric artery.
- Left crus of diaphragm
- Left supra renal gland
- Left kidney
- Left renal vessels
- Splenic vein
6. Inferior - Duodenojejunal flexure
surface - Coils of jejunum
- Left colic flexure
Note: Splenic vein in relation with posterior surface
but splenic artery in relation with superior border of
body of pancreas.

Anatomy
Tail of pancreas: - Opens into minor duodenal papilla (6–8cm

- Lies in Lienorenal ligament together with from pylorus)
splenic vessels. - The opening of the accessory duct lies cranial
and ventral to that of the main duct.
Note:
- Maximum amount of insulin is produced in tail of Note:
pancreas.(KU, MCQ) - The two ducts remind the doubled origin of
- Carcinoma of head of pancreas causes obstructive pancreas from the ventral and dorsal pancreatic
jaundice. (KU, MCQ) buds.
V
Ducts of pancreas a. Main duct: Development from whole of ventral
bud and distal part of duct of dorsal bud.
♦ Exocrine pancreas is drained by two ducts, main
b. Accessory duct: From proximal part of duct of
and accessory.
dorsal bud.-
1. Main pancreatic duct of whirsung
- Begins at tail, runs towards right through body Blood Supply
and bends at neck. Arterial 1. Mainly by pancreatic branches of
- Lumen is 3mm. supply: splenic artery.
- Herring bone pattern. 2. Superior pancreaticoduodenal.
- Joins with bile duct 3. Inferior pancreaticoduodenal.
- Enters wall of second part of duodenum Venous 1. Splenic
- Opens on summit of major duodenal papilla drainage: 2. Superior mesenteric
(8–10 cm from pylorus) 3. Portal veins
2. Accessory pancreatic duct of santorini:
Lymphatic 1. Pancreaticosplenic
- Begins in lower part of head. drainage: 2. Coeliac
- Crosses the front of main duct with which it
3. Superior mesenteric group of lymph
communicates.
nodes.

GIT
Development ♦ Ventral bud ⇒ Forms [MCQ 13 KU]

♦ Formed by 2 buds: Dorsal and ventral i. Uncinate process
♦ Buds originate from endodermal lining and ii. Inferior part of head
duodenum. ♦ Dorsal bud ⇒ Forms: Remaining part
♦ Ventral bud rotates as duodenum rotates to the ♦ Main pancreatic duct/(Wirsung): By entire ventral
right. pancreatic duct and distal part of dorsal
pancreatic duct. V
♦ Ventral bud moves dorsally and lies below and
behind dorsal bud. ♦ Accessory duct/(Santorini): By proximal part of
dorsal bud.

Anatomy
Congenital anomaly: Microscopic structure:

i. Annular pancreas:
• Right portion of ventral bud migrate along
normal route but left portion in opposite
direction.
ii. Accessory pancreatic tissue:
• May be present at wall of duodenum,
jejunum, ileum and Meckel's diverticulum.
V
iii. Inversion of pancreatic ducts
Applied Aspects:
i. Pancreatic cancer: Has exocrine and endocrine portion
– Common in head Exocrine part
– Causes extra hepatic obstruction of biliary - Tubuloacinar gland.
ducts. - Acini are tubular or pear shaped with narrow
– Can–cause obstructive Jaundice, Ascitis. lumen and is surrounded by basal lamina and
ii. Pain from pancreatitis is referred to rich capillary network.
– Epigastrium - Myoepithelial cells are not present.

- In between acini, there is connective tissue
– Posterior paravertebral region
containing blood vessels, lymphatics, nerves
iii. Rupture of pancreas: and excretory ducts.
– Can result from sudden, severe, forceful - Cytoplasm near base of acinar cells is strongly
compression of abdomen. basophilic while supranuclear part is
– Like in automobile accident. acidophilic.
iv. Pancreas is prone to hemorrhage because of rich • Acidophilic → Zymogen granules
blood supply. • Basophilic → RER

GIT
Duct system: Past Questions:

- Has intralobular and interlobular part 1. What is the conjoint tendon (falx inguinale) of
Endocrine part the inguinal canal? Mention its clinical
- Formed by islets of langerhans importance
- Scattered throughout the pancreas but more in (2) [04 Nov]
tail. 2. Mention the boundary and contents of inguinal
canal. (2 +1 = 3) [03 Nov]
- Enclosed by fine capsule of reticular fibers.
3. Mention the location and boundaries of inguinal
- Compact mass polyhedral cells pervaded by canal. (1 +2 = 3) [06 June]
network of fenestrated capillaries. 4. Mention the boundaries and the contents of the
- Four types of cells differentiated inguinal canal. What is Hesselbach's triangle?
• α-cells: 20% of islet cells, usually at Give its clinical importance. (3 +1 + 2 = 6) [08 Dec]
periphery 5. Inguinal ligament (2) [10 July]
• β-Cells: 60–80% islet cells, mostly in center. 6. Formation of rectus sheath at the level of
umbilicus (2)[05 Dec]
• δ -Cells: Small, Scattered
7. Contents of rectus sheath (2)[04 June]
• PP cells: Scattered, few in numbers.
8. Superficial inguinal ring. (2) [07 July]
ANTERIOR ABDOMINAL WALL
Flat muscles
Muscle Origin Insertion Innervation Main Action
External External surfaces of 5th - Linea alba, pubic Thoraco-abdominal
oblique (A) 12th ribs tubercle, and anterior nerves (T7–T11)spinal
half of iliac crest nerves) & subcostal
Compresses and
V
nerve
support abdominal
Internal Thoracolumbar fascia, Inferior borders of viscera, flexes and
oblique (B) anterior two thirds of iliac 10th-12th ribs, linea rotates trunk
crest, and connective tissue alba, and pecten
deep to lateral third of pubis via conjoint
inguinal ligament tendon Thoraco-abdominal
nerves (anterior rami
Transversus Internal surfaces of 7th - 12th Linea alba with of T6-T12 spinal nerves) Compresses and
abdominis (C) costal cartilages, aponeurosis of and first lumbar nerves supports abdominal
throacolumbar fascia, iliac internal oblique, viscera
crest, and connective tissue pubic crest, and
deep to lateral third of pecten pubis via
inguinal ligament conjoint tendon
Rectus Pubic symphysis and pubic Xiphoid process and Thoraco-abdominal Flexes trunk (lumbar
th th
abdominis (D) crest 5 - 7 costal nerves (anterior rami vertebrae) and
cartilages of T6-T12 spinal nerves) compresses
abdominal viscera,
stabilizes and
controls tilt of pelvis
(antilordosis)

Anatomy
Conjoint Tendon or Falxinguinalis ♦ Medially, it is continuous with anterior wall of

♦ Formed by fusion of lowest aponeurotic fibers of rectus sheath and laterally it is free.
internal oblique and of transversus muscle. Function:
♦ Is attached to pubic crest and to the medial part - Strengthens the abdominal wall at site where it
of the pecten pubis. is weakened by the superficial inguinal ring.
Rectus sheath
Formation [05 Dec]
Above costal margin Anterior wall: External oblique Aponeurosis.
Posterior wall: Deficient , rests directly on 5th, 6th, 7th costal cartilage.
Between costal margin and arcuate Anterior wall:
line 1. External oblique aponeurosis.
2. Anterior lamina of aponeurosis of the internal oblique.
Posterior wall:
1. Posterior lamina of aponeurosis of internal oblique.
2. Aponeurosis of transversus muscle.
Below arcuate line/At the level of Anterior wall:
umbilicus [05 Dec] 1. Aponeurosis of all 3 flat muscles of abdomen.
Posterior wall:
– Deficient
– Rectus muscle rests on fascia transversalis (MCQ 2013 KU )
Boundaries
Anterior – Complete
wall: – Composition is variable (described
V above)
– Is firmly Adherent to the tendinous
intersection of the rectus muscle.
Posterior – Incomplete
wall: – Deficient above costal margin and
below arcuate line.
– Uniform composition (described above)
– Is free from rectus muscle.
Contents [04 June]
Muscles: – Rectus abdominis
– Pyramidalis
Vessels: Arteries:
– Superior epigastric artery
– Inferior epigastric artery
Veins:
– Superior epigastric vein
Note: Midway between umbilicus and the pubic
– Inferior epigastric vein
symphysis, the posterior wall of rectus sheath ends in
Nerves: – Terminal parts of lower 6 thoracic nerves.
the arcuate line or line a semicircularis or fold of
– Lower 5 intercostal and subcostal nerves
Douglas.
GIT
Note: Posterior 1. In whole extent:

– Superior epigastric artery is branch of internal wall: – Fascia transversalis, extraperitoneal
thoracic artery. tissue, parietal peritoneum.
– Inferior epigastric artery is branch of external iliac 2. In lateral 1/3rd:
artery. – Interfoveolar ligament
3. In medial 2/3rd:
Inguinal canal – Conjoint tendon, reflected part of
Boundaries [03 Nov,06 june,08Dec] inguinal ligament
Roof – Arched fibers of internal oblique and

Anterior 1. In whole extent: Skin, superficial
transversus abdominis
wall: fascia, ext. oblique aponeurosis.
2. In lateral 1/3rd: Fleshy fibers of internal Floor – Upper surface of Inguinal ligament
oblique – Lacunar ligament
Content of canal [03 Nov, 06 June, 08 Dec] 3. Vein: Pampiniform plexus of veins.
In males: In females: 4. Nerves: Genital branch of genitofemoral, sympathetic
nerves around artery of ductus deferens.
1. Spermatic cord 1. Round ligament of 5. Lympatics: Lymph vessels from testis
uterus
6. Remnant of processus vaginalis.
2. Ilioinguinal nerve 2. Ilioinguinal nerve Inguinal ligament [10 July]
Contents of spermatic cord: - Formed by lower border of external oblique
1. Ductus deferens aponeurosis.
2. Arteries: Cremastric, Artery of ductus deferens - Extends from Anterior superior iliac spine to
and Testicular (@ CAT) pubic tubercle.

Anatomy
- Extensions: i. Congenital vaginal

1. Pectineal ligament of cooper ii. Congenital funicular
2. Pectineal part of inguinal ligament or iii. Bubonocele
lacunar ligament. Direct inguinal Indirect inguinal
3. Reflected part of Inguinal ligament. hernia hernia
1. Aetiology Weakness of Performed sac
posterior wall of
inguinal canal
2. Precipitating Chronic -
bronchitis
3. On standing comes out Does not come
out
4. Direct of the It comes out of Sac comes
sac Hesselbach's through the deep
triangle inguinal ring
Inguinal hernias: 5. Obstruction not common Common, as neck
- Abnormal protrusion of abdominal contents because neck is is narrow
into the inguinal canal. wide
- More likely by chronic cough, work involving 6. internal ring The swelling is Not seen
frequent lifting of heavy weights etc. occlusion seen
V
Types: test
1. Direct: Hesselbach's triangle [08 Dec]
– Contents of hernia enter inguinal canal, not - Triangular gap at posterior wall of Inguinal
through deep ring but through posterior canal.
wall (medial to inferior epigastric artery).
Boundaries:
(i.e. through Hesselbach's triangle)
- Medially: Lateral border of rectus abdominis.
– Can be either medial direct or lateral direct
- Lateral: Inferior epigastric artery
divided by obliterated umbilical artery.
- Below: Inguinal Ligament
2. Indirect:
Significance
– Contents enter inguinal canal through deep
inguinal ring. 1. Direct inguinal hernia pass through this
triangle.
– And pass through inguinal canal, superficial
inguinal ring into the scrotum. 2. Obliterated umbilical artery, divides this
triangle into medial and lateral parts.
– Can be either:

GIT
POSTERIOR ABDOMINAL WALL

Muscles
Muscle Superior Attachment Inferior Attachment Innervation Main Action
Psoas major Transverse processes of By a strong tendon to Anterior rami Acting inferiorly with iliacus,
lumbar vertebrae; sides of lesser trochanter of of lumbar it flexes thigh; acting
bodies of T12-L5 vertebrae and femur nerves L1, L2, L3 superiorly it flexes vertebral
intervening intervertebral column laterally; it is used to
discs balance the trunk; when
sitting it acts inferiorly with
iliacus to flex trunk
Illiacus Superior two thirds of iliac Lesser trochanter of Femoral nerve Flexes thigh and stabilizes
fossa, ala of sacrum, and femur and shaft (L2-L4) hip joint; acts with psoas
anterior sacro-iliac ligaments inferior to it, and to major
psoas major tendon
Quadratus Medical half of inferior border Illiolumbar ligament Anterior Extends and laterally flexes
lumborum of 12 ribs & tips of lumbar and internal lip of iliac branches of T12 vertebral column, fixes 12th
th
transverse processes crest and L1-L4 nerves rib during inspiration

Fascia
Thoracolumbar fascia:
External oblique
Internal oblique V
Transversus abdominis
Fascia transversalis
Renal fascia
Kideny
Psoas fascia
Thoracolumbar fascia
- Also called lumbar fascia

- Fascia enclosing deep muscles of back
- Consists of 3 layers: Posterior, middle and
anterior.
Extent:
- Posterior layer: Covers loin and continue
upward on back of thorax and neck.
- Anterior and middle layer: Confined to lumbar
region.

Anatomy
Abdominal aorta Tributaries:

1. Common Iliac [Median sacral vein joins
♦ Extent: T12– L4
common iliac] vein.
♦ From aortic opening of diaphragm to L4 where it 2. Third and fourth lumbar veins.
divides into right and left common iliac arteries. 3. Right testicular or ovarian vein.
Branches: 4. Renal veins
5. Right Supra renal vein.
Vertebral
Arteries 6. Hepatic veins.
level
Ventral 1. Coeliac trunk T12
branches 2. Superior mesenteric L1
3. Inferior mesenteric L3
Lateral 1. Inferior phrenic T12
branches 2. Middle suprarenal L1
3. Renal L1
4. Testicular or ovarian L2
Dorsal 1. Lumbar L1 – L4
branches 2. Median sacral
Terminal Pair of common Iliac L4
branches
Lumbar plexus
♦ Formation and braches:
Inferior venacava
Formation:
- Formed by union of right and left common Iliac
veins on the right side of the body of vertebra L5.
- Ascends in front of vertebral column, on the
right side of the aorta, grooves the posterior
surface of liver → Pierces central tendon of
diaphragm (T8) and opens into lower and
posterior part of right atrium.

GIT
♦ Formed by ventral rami of upper four lumbar ♦ Situated in front of first and second lumbar
nerves. vertebrae, immediately to the right of abdominal
♦ First lumbar nerve receives contribution from the aorta.
subcostal nerve. ♦ Upper end is continuous with thoracic duct.
♦ Fourth lumbar nerve gives contribution to the ♦ It is joined by right and left lumbar and intestinal
lumbosacral trunk. lymph trunks.
Branches Root value ♦ Intestinal trunk brings lymph from:
1. Stomach
Iliohypogastric nerve L1, Anterior ramus
2. Intestine
Ilioinguinal nerve L1, Anterior ramus
3. The pancreas
Genito femoral nerve L1, L2 ventral division 4. The spleen
Lateral Cutaneous nerve L2, L3 dorsal division 5. Anteroinferior part of the liver.
of thigh ♦ Lumbar trunk brings from:
Femoral nerve L2,L3, L4 dorsal division 1. Lower limbs
Obturator nerve L2, L3, L4 ventral division 2. The pelvic wall and viscera
Lumbosacral trunk L4, L5 ventral rami 3. The kidneys

4. Supra renal glands
Cisterna chyli
5. Testes or ovaries.
♦ Elongated lymphatic sac
6. Deeper parts of the abdominal wall.
♦ 5-7 cm long.
V

Anatomy
SPECIAL POINTS FOR MCQs

1. Umbilicus:
- Level of umbilicus is watershed.
- Lymph and venous blood flow upwards above the plane of umbilicus and downward below
this plane.
- Lymphatic drainage of umbilicus is to both axillary and inguinal lymphnode.
- Above the level of umbilicus drain into axillary lymph nodes and below the level of umbilicus
drain into superficial inguinal lymph nodes
- Cutaneous venous drainage:
• In venacaval obstruction, the Thoracoepigastric vein open up, connecting the great
saphenous vein with axillary vein.
→ In superior V.C. obstruction, direction of flow is downwards breaking barrier of
water shed line.
→ In IVC obstruction, direction of flow is upwards crossing the water shed line
- Supplied by T10 segment of spinal cord
2. Fascia
- Superficial fascia anterolateral abdominal wall
Superficial fatty layer /campars fascia Deep membranous layer/scarpas fascia
In Perineum: In perineum:
i. Superficial fascia of surrounding region. i. Colles fascia
V
ii. Investing or gallaudet's fascia
In penis: In penis:
Devoid of fat i. Bucks fascia
ii. Fundiform ligament (More superficial than
suspensory ligament)
iii. Suspensory ligament
In scrotum:
- Dartous fascia
- Holden's line is related with attachment of scarpa's fascia of abdomen and colle's fascia of
perineum and prevents passage of extravasated urine.
3. Hesselbach's triangle
i. Lateral border: Epigastric artery
ii. Medial border: Lateral border of rectus abdominis where it is attached to pubic crest
iii. Base: Inguinal ligament
4. Epiploic foramen/foremen of winslow
- It is a vertical slit like opening through which the lesser sac communicates with the greater
sac.
- It is situated behind right free margin of lesser omentum at T12 vertebra level
- Mostly boundaries are asked in MCQs (study from theory)

GIT
5. Peritoneal folds of intestine

Peritoneal folds of intestine
Mesentery proper Mesoappendix Transverse Sigmoid

Mesocolon Mesocolon
Border Contains:
i. Root: i. Root:
i. Root/Attached boarder: i. Vessels - Attached to anterior - Inverted V
- 15 cm long (Appendicular surface of the head shaped
- Directed obliquely downwards & artery) and anterior border - contains sigmoid
to the right ii. Nerves & of body of pancreas & superior rectal
- From dudenojejunal flexure on the lymphatics - Upward inclination vessels, nerve and
left side of vertebra L2 to upper supplying towards left lymphatics of
part of the right sacroiliac joint appendix - Contains middle sigmoid colon.
- It crosses colic vessels &
• 3rd part of deodenum nerves and
• Abdominal aorta lymphatics of
• IVC transverse colon.
• Right ureter, Right psoas major,
Right gonadal vessels
ii. Free/intestinal border
- 6 meter longs
- thrown into pleats
6. Lesser Sac/Omental Bursa:
- Subdivision:
• Divided into superior and inferior recess by right and left gastropancreatic folds formed due to
downward and forward course of hepatic artery and upward course of left gastric artery
V
• Superior recess lies behind lesser omentum and liver.
• Inferior recess lies behind stomach and with the greater omentum.
7. Blood supply of soft palate:
- Greater palatine artery (branch of descending palatine artery which is branch of maxillary
artery)
- Lesser palatine artery (branch of descending palatine artery which is branch of maxillary
artery)
- Ascending palatine artery (branch of facial artery)
- Palatine branch of ascending palatine artery
8. Waldeyr's ring is formed by palatine, lingual, pharyngeal and tubual tonsils
9. Inguinal canal:
- Superficial inguinal ring is triangular gap in external oblique aponeurosis.
- Deep inguinal ring is oval opening in fascia transversalis.
- Inguinal canal is about 4cm is length but larger in males than in females.
- Testicular vein is not constituent of spermatic cord.
- Spermatic cord is covered from within outwards: internal spermatic fascia, cremastericfascia,
external spermatic fascia
- Triangle of Doom:
• Vas deferens medially • Gonadial vessels laterally

Anatomy
- Circle of death (Vascular ring):

• Common iliac artery • Internal iliac • External iliac
• Obturator • Accessory obturator • Inferior epigastric artery
10. Fascia Derived from
a. Internal spermatic fascia - Fascia transversalis
b. Cremasteric fascia - Internal oblique + transversus abdominis
c. External spermatic fascia - External oblique aponeurosis
11. Abdominal Wall:
- Conjoint tendon is formed by internal oblique and transverses abdominis.
- Cremaster muscle is supplied by genital branch of genitofemoral nerve.
- Cremastric artery is branch of inferior epigastric artery.
- The inner surface of abdominal muscles is lined by fascia. This part of fascia which lines inner
surface of transversus abdominis muscle is called 'fascia transversalis'.
• It forms anterior wall of femoral sheath.
- Over 75% strength of intact abdominal wall is in aponeurosis.
- Main antagonist muscle of rectus abdominisis: "Erector spinae"
- Pyramidalis is supplied by: Subcostal nerve.
- Linea alba and external oblique poorly formed in lower 1/4th anterior abdominal wall.
12. Tongue:
- Tip of tongue drains to submental lymphnodes.
- Pain due to cancer of base of tongue is also referred to ear through glossopharyngeal nerve.
V
- Pain in posterior 1/3rd of tongue after tonsillectomy is due to injury to IX nerve.
- Circumvallate papillae of tongue are supplied by glossopharyngeal nerve.
- Ipsilateral deviation of tongue (on lower motor neuron lesion of hypoglossal nerve) is due to
unaltered action of genioglossus.
13. Esophagus:
- Esophagus enters through muscular part of diaphragm at level of level of T10 vertebra.
- Esophagus is lined by stratified squamous non keratinized epithelium.
- Upper 1/3rd of esophagus has skeletal muscle.
- Esophagus is accompanied by vagus nerve, esophageal branch of left gastric artery.
- Esophagus enters through muscular part of diaphragm
14. Stomach:
- Gastroduodenal artery ruptures during duodenal ulcer while bleeding left gastric artery
during gastric ulcer.
- "Prepyloric vein of myo" lies in front of pyloric constriction.
- Mucus secreting cells are more abundant in pylorus of stomach.
Chief cells abundant in fundus.
- Nerve of literate of vagus is seen in stomach.
- Gastric rugae are temporary i.e. not permanent mucosal folds.
1
- Mean capacity of stomach is 30ml at birth, 1 litre at puberty, 1 2 to 2 liters or more in adult.

GIT
15. Duodenum:
- Duodenal cap is due to first part of duodenum.
16. Pancreas:
- Pancreas is at level of L1 – L2
- Posterior surface of pancreas is devoid of peritoneum
- Most common site of ectopic pancreatic tissue are stomach and diverticulum.
- Islets of langerhans are more common in 'tail of pancreas'. [KU, MCQ]
17. Raspberry/cherry red tumor is in remnants of vitellointestinal duct.
18. Structures corresponding to transpyloric plane :
- Region close to hila of the left and right kidneys
- Level of the emergence of superior mesenteric artery from the abdominal aorta
- Level of L1 vertebra
- Level of the pylorus
- Level of the point at which the lateral border of the rectus abdominis meets the costal margin
- Level of the first part of the duodenum
- Neck of pancreas
19. The angle between the last rib and border of erector spinae is known as renal angle. (MCQ 2013 KU)
20. Dartos muscle in scrotum is replacement of superficial fatty layer (fascia of camper)
21. "Stave cells" line splenics inusoides.
22. Tortuous arteries:
Facial artery Lingual artery Splenic artery
PICA Uterine artery Vaginal artery
Opthalmic artery
V
23. Gland
Gland Duct Type of gland Duct of opening
Parotid Stensons duct Serous acini only Vestibule of mouth , opposite
to second upper molar
Submandibular Wharton's duct Mixed: predominantly serous On floor of mouth on summit
of sublingual papilla on side of
frenulum of tongue
Sublingual Bartholins duct Mixed: predominantly mucus On the floor of mouth , on
summit of sublingual papillae
24. Meckel's diverticulum (2) [10 July]
- Rule of 2's in meckel's diverticulum:
• 2% (population)
• 2 feet (from ileocaecal valve)
• 2 inches (in length)
• 2% are symptomatic
• 2 types of common ectopic tissue (gastric and pancreatic)
• Most common age at clinical presentation is 2.
• Males are 2 times as likely to be affected.
- Meckels diverticulum arises from antimesenteric border of ileum.
25. Plica circularis, spiral valve of Heister, Transverse rectal folds are permanent fold.

Anatomy
26. Superior rectal artery is branch of inferior mesenteric but middle rectal is branch of internal iliac
artery.
27. Anal continence is not contributed by Houston valve.
28. Posteriorly perforating ulcer is pyloric antrum of stomach is most likely to produce initial localized
peritonitis or abscess formation in "omental bursa".
29. Common structure in Heselbach's triangle and femoral triangle is inguinal ligament.
30. Greater superficial petrossal nerve supplies lacrimal gland and lesser petrossal supplies parotid.
31. Anal Canal
Anal canal above pectinate line Anal canal below pectinate line/ dentate line
- Endodermal - Ectodermal
- Cuboidal epithelium - Stratified squamous
- Superior rectal artery, vein - Inferior rectal artery, vein
- Internal iliac group lymph nodes - Superficial inguinal group
- Pain insensitive - Pain sensitive
- Internal anal sphincter is part of internal circular fibers.
- Anal canal zones:
Middle (Transitional or Pecten)
Upper Mucous Zone Lower (cutaneous) zone
zone
- 15 mm (1.5 cm) - 15 mm (1.5 cm) - 8 mm( 0.8cm)
- Simple columnar mucous - Non Keratinized staratified - Non Keratinized staratified
membrane showing anal squamous epithelium squamous epithelium with
columns of morgagni, anal without sweat and sebaceous sweat and sebaceous gland
valves, anal sinus, anal gland and hair follicle and hair follicle
papilla.
V - Pain insensitive - Pain sensitive - Pain sensitive
- Dentate/Pectinate line lies between upper and middle part
- Anal glands open at the dentate line
- White line of Hilton lies at lower limit of middle (transitional) part
• Upper mucous zone
→ 15 mm (1.5 cm)
→ Simple columnar mucous membrane
32. Cystic artery arises from right hepatic artery. (MCQ 2013 )
33. Colon is supplied by marginal artery.
34. Cutting and cauterisation don't produce visceral pain.
35. Hiatus hernia is most common type of diaphragmatic hernia.
36. Ascending colon ⇒ Length = 12.5cm
Transverse colon ⇒ 50cm
Descending colon ⇒ 25cm
Sigmoid colon ⇒ 37.5 cm
Rectum ⇒12cm
Anal canal ⇒ 3.8cm
i.e. Shortest colon ⇒ Ascending colon
Longest part of colon ⇒ Transverse colon
37. Iliac crest at the level L4.

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GIT

FAST TRACK BASIC SCIENCE MBBS -5-

-6- FAST TRACK BASIC SCIENCE MBBS

GROSS ANATOMY Embryological importance:

FAST TRACK BASIC SCIENCE MBBS -7-

ORAL CAVITY - In man: Teeth replaced only once so called

1. Pulp: Contains vessels, nerve and ↓

Development: - Muscles from: 1st, 4thand 6th branchial arches.

FAST TRACK BASIC SCIENCE MBBS -9-

2. Muscular uvula - Near the median plane palatine - Pulls up uvula

3. Levator veli palatine - Superior surface of palatine - Elevates soft plates

5. Palatoglossus - Inferior surface of palatine - Pulls up root of

-10- FAST TRACK BASIC SCIENCE MBBS

2. Extrinsic muscles [05 June]

FAST TRACK BASIC SCIENCE MBBS -11-

Parts of the tongue

-12- FAST TRACK BASIC SCIENCE MBBS

Structure within parotid gland [08 Dec]

FAST TRACK BASIC SCIENCE MBBS -13-

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FAST TRACK BASIC SCIENCE MBBS -15-

Comparison between nosopharynx, oropharynx and laryngopharynx

-16- FAST TRACK BASIC SCIENCE MBBS

- It is loosely attached to the walls by extra-

FAST TRACK BASIC SCIENCE MBBS -17-

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FAST TRACK BASIC SCIENCE MBBS -19-

Lesser Sac or omental bursa Boundaries:

Applied Aspects: Recto uterine pouch of Douglas

-20- FAST TRACK BASIC SCIENCE MBBS

FAST TRACK BASIC SCIENCE MBBS -21-

Constrictions: 4 constrictions normally [08]

-22- FAST TRACK BASIC SCIENCE MBBS

STOMACH These structures are:

FAST TRACK BASIC SCIENCE MBBS -23-

Venous drainage: Nerve supply

-24- FAST TRACK BASIC SCIENCE MBBS

Congenital anomaly: d. Nerve supply is more abundant, with large

1. Mucosa: Simple columnar epithelium iii. Pyloric glands:

FAST TRACK BASIC SCIENCE MBBS -25-

SMALL INTESTINE ♦ 6m long

1. Mention the extent and relations of second part Duodenum:

-26- FAST TRACK BASIC SCIENCE MBBS

FAST TRACK BASIC SCIENCE MBBS -27-

- Venous drainage: Splenic, superior mesentric

-28- FAST TRACK BASIC SCIENCE MBBS

JEJUNUM AND ILEUM 2. Describe the differences between the jejunum

Differences between Jejunum and ileum [09 July, 03 Nov]

Features Jejunum IIeum

2. Walls Thicker and more vascular Thinner and less vascular

3. Lumen Wider and often empty Narrower and often loaded

4. Mesentery a. Window present a. No windows

8. Solitary lymphatic Fewer More numerous

- Villi are taller and - Villi are shorter and

FAST TRACK BASIC SCIENCE MBBS -29-

Blood supply: - This rotation is counter clockwise, Aprox. 270°

Parts 2. Fixed except Appendix, transverse colon and

Position [04 July] 3. Splenic 1. Upward to left

-32- FAST TRACK BASIC SCIENCE MBBS