Gastrointestinal

system
Oral cavity
Tongue
Esophagus
Stomach
Duodenum
Jejunum
Ileum
Colon
Rectum
Anal canal
Liver and pancreas

Oral cavity
Begins in the Mouth , otherwise known as
the "Buccal Cavity.
Divided into vestibule, lips, cheeks, oral
cavity proper and teeth.
Vestibule:- narrow space bounded
externally by the lips and the cheeks, and
internally by the teeth and gums.
Parotid duct opens on the inner surface of
the cheek opposite the crown of the 2
nd

molar tooth.

Lips:- are fleshy folds lined externally by
skin and internally by the mucous member.

Cheeks:- are fleshy flaps, continuing in the
front with the lips, and the junction is
indicated my the nasolabial sulcus which
extend from the side of the nose to the
angle of the mouth.

Oral cavity proper:- bounded
-anterolaterally by the teeth, the gum
and the alveolar arches of the jaws.
-Roof:- formed by hard and soft palate.
-Floor:- by tongue posteriorly and
sublingual region anteriorly, below the
tongue.

Posteriorly, the cavity communicates with
the pharynx.
Gums (Gingivae):- are soft tissues which
envelop the alveolar processes of the
upper and lower jaws and surround the
neck of the teeth.

Tongue
Tongue:- The tongue is a skeletal muscle
(voluntary) on the floors of the mouths.
Approximately 3inch long.
Muscles of tongue:- The eight muscles of the
human tongue are classified as either intrinsic or
extrinsic.
The four intrinsic muscles act to change the
shape of the tongue, and are not attached to any
bone.
The four extrinsic muscles act to change the
position of the tongue, and are anchored to bone.
Shape
a root
an apex
dorsum surface
inferior surface


apex
root
body
Oral part
Pharyngeal part
terminal sulcus
The mucous membrane of the inferior
surface of the tongue:
Frenulum of tongue
Sublingual caruncle
Sublingual fold
Frenulum of tongue
Sublingual caruncle
Sublingual fold
Extrinsic muscles:- originate from bone and
extend to the tongue and their main functions
are altering the tongue's position allowing for
protrusion, retraction, and side-to-side
movement.
-Genioglossus
-Hyoglossus
-Styloglossus
-Palatoglossus

Intrinsic muscles:-
The main function
of the intrinsic
muscles is to
provide shape.
-Superior longitudinal
-Inferior longitudinal
-Vertical
-Transverse

Blood supply;- lingual artery, tonsillar and
pharyngeal artery.

Lymphatic drainage:- tip of the tongue
drain into submental nodes, and right and
left halves of anterior 2/3
rd
drain into
submandibular nodes, and posterior 1/3
rd

drain into Jugulo-omohyoid lymph node.
Never supply
Anterior 2/3rds of tongue
-General somatic afferent: lingual nerve
branch of V3 of the trigeminal nerve CN V
-Taste:- chorda tympani branch of
facial nerve CN VII (carried to the tongue
by the lingual nerve).
Posterior 1/3rd of tongue
-General somatic afferent and taste:
Glossopharyngeal nerve CN IX.
Motor:- All intrinsic and extrinsic muscles
of the tongue are supplied by the
hypoglossal nerve (CN XII), except for one
of the extrinsic muscles, Palatoglossus,
which is innervated by CN X of the
pharyngeal plexus.
The Palate
Constitutes:
the roof of the mouth
the floor of the nasal
cavity.
Composition:
hard palate(2/3)
soft palate(1/3)

hard palate
soft palate
Teeth
The Teeth (Dentes)
Two sets of teeth in man: Deciduous (milk)
and permanent.

Basic shape:
Crown
Neck (cervix)
Root (or roots)

Structure:
Enamel
Dentine
Cement
Periodontal
membrane
Dentine
Enamel
Cement
Periodontal
membrane
Crown - exposed surface of tooth.
Neck - boundary between root
and crown.
Enamel - outer surface
Dentin bone-like, but noncellular
Pulp cavity - follow with blood
vessels and nerves
Root canal - canal length of root
gingival sulcus - where gum and
tooth meet.
Types and Numbers of Teeth
Dental succession
Deciduous (baby, milk) teeth - 20, replaced by
Permanent teeth - 32 teeth
The Salivary Glands
The major salivary glands
parotid gland
submandibular gland
sublingual gland
). The Parotid Gland
Parotid Gland
papilla
). The Submandibular Gland
Submandibular Gland Submandibular duct
Sublingual
caruncle
Sublingual Gland Sublingual duct
Sublingual
caruncle
). The Sublingual Gland
Sublingual fold
Name Shape Location
Duct meatus
Parotid gland Three sided
pyramid
anterior and
inferior to the
external acoustic
meatus, overlying
the ramus of
mandible.
Opposite of the
upper 2
nd
molar
tooth
Submandibular
gland
Lying superior to
the digastric
muscles.
Opens on the floor
of the mouth, at
the side of the
frenulum of the
tongue.
Sublingual gland Almond shape Lie anterior to the
submandibular
gland under the
tongue.
Opens directly into
the floor of the
mouth.
Pharynx
go thro respiratory system..
Esophagus
The esophagus is a narrow muscular
tube through which food passes from the
pharynx to the stomach.

It is usually about 25 cm long.

The esophagus is continuous with part of
the pharynx at the level of the C6 vertebra.

The abdominal part of the oesophagus is
only about 1.25cm.
The esophagus passes through posterior
mediastinum in thorax and enters
abdomen through a hole in the diaphragm
at the level of the tenth thoracic vertebrae
(T10).
Nonkeratinized stratified squamous
epithelium.
Muscularis externa
- upper 3
rd
is compose of striated muscles
- middle 3
rd
mixed type
- lower 3
rd
smooth muscles.
Esophageal constrictions
Normally, the esophagus has 4 constrictions at
the following levels.
At the esophageal inlet, where the pharynx joins
the esophagus, behind the cricoid
cartilage,15 cm from the incisor teeth.
Where it is crossed by the aortic arch, 25cm
from the incisor teeth.
Where it is crossed by the left bronchus,
27.5 cm from the incisor teeth.
Where it pierces the diaphragm, 37.5 cm from
the incisor teeth).
The distances from the incisor teeth are
important.
Relation
Anterior:- trachea, right pulmonary artery, left
bronchus, pericardium with left atrium, the
diaphragm
Posterior:- vertebral column, right posterior
intercostal arteries, thoracic duct, azygos vein,
thoracic aorta, right pleural recess and
diaphragm.
To the left:- aorta, left subclavian artery,
thoracic duct, left lung and pleura, left recurrent
laryngeal nerve.
To the right:- right lung and the pleura, azygos
vein and the right vagus.
Arterial supply:- cervical part by branch of
inferior thyroid artery, thoracic part by
esophageal branch of the aorta, and
abdominal part by branches of left gastric
artery.
Venous drainage:- upper part drain into
brachiocephalic vein, middle part goes to
azygos vein and lower part goes to left
gastric vein.
The lower end is one of the sites for
protosystemic anastamosis.
Lymphatic drainage:- cervical part drain into
deep cervical nodes, thoracic part to the
posterior mediastinal nodes and abdominal part
to left gastric nodes.
Nerve supply:-
- Parasympathetic, upper half by recurrent
laryngeal nerve and lower half by oesophageal
plexus. Nerves are sensor, motor and
secretomotor to the oesophagus.
- Sympathetic:- upper half by fibers of middle
cervical ganglion and lower half by upper four
thoracic ganglia. Nerves are vasomotor.
Stomach
The Stomach
esophagus
duodenum
Liver
Kidney
Transverse colon
spleen
Gallbladder
diaphragm
Cardia
Pylorus
Also known as gaster or venter, and is a
muscular bag, hollow, dilated part of the
digestion system.

It is located between the esophagus and
the small intestine.

It acts as a reservoir of food and helps in
digestion of carbohydrates, proteins and
fats.
Location:- it lies obliquely in the upper and
left part of the abdomen, occupying the
epigastric, umbilical and left
hypochondriac region.
Most of the stomach lies under cover of
the left costal margin and the ribs.
Shape and position:- when empty,
stomach is J-shaped (vertical), when
partially distended, it become pyriform.
Size:- it is 25cm long, and mean capacity
is one ounce (30ml) at birth, one litre at
puberty and 1.5 to 2litres or more in adults.
External features:-
- two orifices or openings,
- two curvatures or borders, and
- two surfaces.
Two orifices:- cardiac orifice is joined by lower
end of oesophagus and it lies behind the 7
th

costal cartilage 2.5cm from the junction with the
sternum, at the level of T11 vertebra.
- pyloric orifice opens into duodenum, it lies
to the right of the medial plane, at level of lower
border of L1 vertebra.
Two curvatures:- lesser curvature is
concave and forms the right border of the
stomach and attached to lesser omentum.
The most dependent part is the curvature
is marked by the angular notch or incisura
angularis.
- greater curvature is convex and form
the left border and attached to greater
omentum, the gastrosplenic ligament and
the gastrophrenic ligament. At upper end it
present cardiac notch which separates it
form oesophagus.
) Two curvatures
pyloric antrum
pyloric canal
greater curvature
lesser curvature
angular incisure
Two surfaces:- anterior or anterosuperior
surface faces forward and upward
-Posterior or posteroinferior surface
faces backward and downward.

Two surfaces
1. anterior surface
2. posterior surface
The stomach is divided into 2 parts:-
- Cardiac and
- Pylorus
..by the line drawn downwards and to the
left form the incisura angularis.

Cardiac part is further divided into fundus
and body.
The gastric glands distributed in the
fundus and body of the stomach,
containing all three types of secretory cells
i) mucous cells ii) the chief, peptic or
zymogenic cells and iii) the parietal or
oxyntic cells
Pyloric part is divided into pyloric antrum
(7.5cm) and pyloric canal (2.5cm).
Four parts
fundus
body
pyloric part
pyloric antrum
pyloric canal
Angular incisure
cardiac part
cardiac incisure
Relations of the Stomach
Peritoneal relations:- stomach is lined by the
peritoneum on both its surface. At lesser
curvature it forms lesser omentum and at greater
curvature it forms the greater omentum.

Near the fundus the two layers meet to form
gastrosplenic ligament and near the cardiac end
the peritoneum on the posterior surface forms
gastrophrenic ligament.

Visceral relations:- the anterior surface of
the stomach is related to the liver, the
diaphragm, and the anterior abdominal
wall.

The posterior surface is related to the
structures forming stomach bed. i)
diaphragm, ii) the left suprarenal gland, iii)
left kidney, iv) pancreas, v) transverse
colon, vi) splenic flexure of the colon, vii)
splenic artery, sometime spleen.
Interior of Stomach
Mucosa
Submucosa
Muscularis
Serosa .


Musculature and Inner Surface
) The musculature of the stomach
Three layers of smooth muscle
outer longitudinal layer:
inner circular layer: uniform, pyloric
sphincter ---- a thickened muscular ring at
the pylorus
Internal to circular muscles: an incomplete
layer of oblique muscle.
longitudinal layer
circular layer
oblique layer(incomplete)
Pyloric sphincter
) The inner surface of the stomach
The mucosa : thick.
Gastric ulcers
neoplasms
Blood supply
Lymphatic drainage
It can be divided into 4 territories:-
Area a or pancreaticosplenic nodes
Area b or left gastric nodes
Area c or right gastroepiploic nodes
Area d or pyloric nodes
Nerve supply
The stomach is supplied by sympathetic and
parasympathetic nerves.

Sympathetic nerves are derived from T6 to T10
segments of the spinal cord, via the greater
splanchnic nerves and coeliac and hepatic
plexuses.

Pathway for the pain sensations from the
stomach.
Parasympathetic nerves are derived from the vagus,
through oesophagus plexus and gastric nerves.
Anterior or left vagal fibres divides into i) gastric
branch for anterior surface of the fundus and body
of stomach, ii) two pylorus branches
Posterior or right vagal fibres divides into i) smaller
gastric branches for the posterior surface of the
fundus, body and antrum, ii) larger, coeliac
branches for the coeliac plexus.
It stimulates to increase the motility of the stomach
and secretion of the gastric juice rich in pepsin and
HCL
Functions
Reservoir of food.
Mixing of food with the gastric juice by peristaltic
movement.
Secrets gastric juice via gastric gland help in
digestion of the food.
Produce HCL which destroys many organisms
present in food and drinks.
Protect the gastric mucosa from HCL by
producing mucus.
Absorption of drugs, water, salt, alcohol etc.
Produce intrinsic factor which helps in the
absorption of Vitamin B12.