ANATOMY OF

GASTROINTESTINAL SYSTEM

Ahmad Azwar Habibi

Lab.Anatomi FKIK UINSH

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 TOPICS

• Competencies of GI system  SKDI

• Overview:
– Gastrointestinal tract
– Accessory organ
• Biomedical and Clinical Anatomy
• Case studies

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SKDI : DAFTAR PENYAKIT

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SKDI : DAFTAR KETRAMPILAN KLINIS

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 SASARAN/KELUARAN:
1. Mampu mengidentifikasi struktur anatomi kedokteran dasar
(struktur makroskopis, topografi, vaskularisasi, innervasi dan
anatomi superfisial) dari anatomi sistem gastrointestinal
2. Mampu menjelaskan struktur anatomi tersebut terkait fungsi,
interaksi dan implikasinya dalam keadaan normal maupun
patologis
3. Mampu mengidentifikasi dan menjelaskan struktur anatomi
kedokteran dasar melalui pencitraan radiologi
4. Mampu menerapkan pengetahuan anatomi dalam kegiatan
ketrampilan klinis dasar

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 SKDI : DAFTAR MASALAH

• Diare • Sendawa
• Nyeri perut • Cegukan
• Perut kembung • Nyeri ulu hati
• Muntah • Nyeri sesudah makan
• Sulit BAB/sembelit • Kelainan tinja
• Sakit dan sulit menelan • Ambein
• Mulut kering • Nyeri saat BAB
• Bau mulut • Gatal daerah anus
• Sakit gigi • Perdarahan saat BAB
• Sariawan • Nyeri daerah anus
• Bibir pecah-pecah • Muntah darah
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 OVERVIEW :
GASTROINTESTINAL SYSTEM

• Gastrointestinal
Tract (alimentary
canal/digestive tube)
– The mouth, pharynx,
esophagus, stomach,
small & large
intestine.

• Accessory digestive
organs
– Teeth, tongue.
– Digestive glands:
salivary glands, liver,
gallbladder,
pancreas.
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 GI SYSTEM  ABDOMEN
• Boundaries:
– Superior: xyphoid process & costal margin
– Posterior: vertebral column
– Inferior: upper parts of the pelvic bones.

• Layers of abdominal wall : …

• Muscles of anterior abdominal wall:

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

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 ORGANIZATION OF
THE RECTUS SHEATH

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ABDOMINAL WALL
INGUINAL REGION

Inguinal ligament
• Inguinal canal
• Structures passing
through the canal
(male & female)
• Superficial inguinal
ring (annulus
inguinalis medial/
superficial)
• Deep inguinal ring
(annulus inguinalis
lateral /profundus)
• Conjoint tendon
• Inguinal hernias:
direct & inderect
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PERITONEUM
• A membrane that lines the walls of
the abdominal cavity and covers
much of the viscera.
• Divided into:
– Parietal peritoneum
– Visceral peritoneum
• Peritoneal folds: suspend the
organs; in the peritoneal cavity 
intraperitoneal

• Organs outside the peritoneal

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

• Peritoneal folds:
– Omenta :the folds suspending
the stomach
– Mesenteries: the folds
suspending the small and
large intestines
– Ligament 14
PERITONEUM
• Peritoneal cavity: potential
space enclosed within the
peritoneum.

• The peritoneal cavity is

divided into:
– The greater sac
– The omental bursa

• Connected by omental
foramen (epiploic foramen
of Winslow)

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 ABDOMINAL REGIONS AND QUADRANTS

Midclavicular plane

Subcostal plane

Transtubercular
plane

(a) (b)

Divisions of the anterior abdominal wall for mapping the digestive

organs into abdominal cavity
(a) The nine surface regions of the anterior abdominal wall
(b) The abdominal viscera as they relate to the nine surface 16
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ABDOMINAL REGIONS AND QUADRANTS

(c) Simpler scheme of four

quadrants centered at the
navel

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 GI TRACT : (1) MOUTH

• Boundaries
• Oral cavity :
– roof, floor, base
– lateral wall

• Right/left to frenulum of
tongue  opening of
submandibular glands
• Opposite to the upper M2
 opening of the parotid
duct

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 (2) PHARYNX

• Lies behind oral

cavity proper
• Divide into 3 parts:
– Nasopharynx:
posterior to
choane
– Oropharynx:
posterior to oral
cavity
– Laryngopharynx:
posterior to larynx
• Open to esophagus at
the level C VI
vertebrae.

SWALLOWING MECHANISM ???

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 (3) ESOPHAGUS

• Muscular tube, + 25 cm
• Begins as a continuation of the
pharynx, at the level of the
vertebra CVI.
• Divided into 3 part : cervical,
thoracic, abdominal – syntopy
with other organs?
• Four location of esophageal
constriction:
– Trachea & laryngeal nerve,
15 cm from the incisive
teeth
– Aorta arch, 22 cm from the
incisive teeth
– Left bronchus, 27 cm from
the incisive teeth
– Diaphragm  esophagus
hiatus, 37 cm from the
incisive teeth
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(4) STOMACH
• J - shaped
• Regions :
– Cardia : opening of oesophagus
into the stomach)
– Fundus (dome shape): area
above the cardiac opening
(orificium cardiaca)
– Body of stomach (corpus)
– Pylorus
• Projection of region ?
• Curvatura major - curvatura minor
• Incisura cardiaca - incisura
angularis

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Relation to other organs (syntopy)

• Fundus : within the curved of

diaphragm
• Body : pancreas & descending
part of diaphragm
• Greater curvature : lies in front
of the left suprarenal gland &
upper part of the left kidney
• Lesser curvature : pancreas &
tuber omentale of the liver
• Posterior surface: splenic artery
& vein
• Anterior surface: abdominal
wall
• Right surface: left & quadrate
lobes of the liver.
• Left surface of the fundus:
spleen
• Caudal part of the greater
curvature: transverse colon 22
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 (5) SMALL INTESTINE
• Extends from the pyloric
orifice of the stomach to the
ileocecal fold.
– Duodenum
– Jejunum
– Ileum

• The mesentery of small

intestine is a broad, fan
shaped fold of peritoneum.
– Suspends the jejunum & ileum
from the posterior abdominal
wall by the root of mesentery.
– Contents: jejunal & ileal
branches of superior mesenteric
vessels, autonomic nerve
plexuses, lymphatics, lymph
nodes, connective tissue fat. 23
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 DUODENUM
• C-shaped
• Rounding the head of the pancreas
• Retroperitoneal, except for its
beginning
• Location: epigastric & umbilical region
• Connected to the liver by
hepatodudenal lig.
• Part of duodenum
• Flexures:
– Superior duodenal flexure
– Inferior duodenal flexure
– Duodenojejunal flexure: surounded by
a fold of peritoneum containing muscle
fibers  ligament of Treitz
• Internal part of duodenum:
– Major duodenal papilla: common
entrance for the bile and pancreatic
ducts
– Minor duodenal papilla: entrance for
the accessory pancreatic duct

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 JEJUNUM & ILEUM

• Jejunum
(proximal 2/5 of
jejunum-ileum;
mostly in left
upper quadrant)

• Ileum (distal 3/5

of jejunum-
ileum; mostly in
right lower
quadrant)
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CHARACTERISTIC OF JEJUNUM & ILEUM

Or “windows”
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Mesentery of jejunum Mesentery of ileum
CHARACTERISTIC OF JEJUNUM & ILEUM

Characteristics Jejunum Ileum

Location Upper left quadrant Lower right quadrant
Diameter 2 – 4 cm 2 – 3 cm
Lumen Wider Narrower
Walls Thicker and more vascular Thinner and less vascular
Circular mucosal folds (plicae
Larger and more closely set Smaller and sparse
circulares)
Windows present No windows
Fat less abundant Fat more abundant
Mesentery Arterial arcade, 1 or 2 Arterial arcades, 3-6
Vasa recta shorter & more
Vasa recta, longer & fewer
numerous
Lymphoid nodules
absent present
(Peyer’s Patches)

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 (6) LARGE INTESTINE

• Extends from the distal end of the ileum to the

anus.
• Approximately 1.5 m long.
• Parts of large intestine:
– Cecum
– Colon
– Rectum
– Anus Appendix epiploicae

• Characteristic: appendices epiploicae, taenia

coli, sacculation (haustra), semilunar fold

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 CECUM & APPENDIX

• The appendix: narrow, hollow

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

Haustra

Semilunar fold

• A large blind sac

• Location: right iliac fossa, inferior to
the ileocecal opening.
• Continuous with the ascending
colon at the entrance of ileum
(ileocecal opening)
• Ileocecal valves: fold of ileocecal
opening
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 CECUM & APPENDIX
• The Base of appendix: attached to the
posteromedial wall of caecum; 2 cm
inferior of ileocecal valve.

• Surface marking of appendix: a point

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

• McBurney point: surface projection of

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

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 APPENDIX

Position of the appendix:

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

Colon consist of:

• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon
• At the junction between:
– ascending & transverse colon :
right colic flexure (hepatic flexure);
just inferior to the right lobe
– Transverse & descending colon: left
colic flexure (splenic flexure); just
inferior to the spleen
• Ascending & descending colon are
retroperitoneal
• Transverse & sigmoid colon are
intraperitoneal

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• Begins at the level
of vertebra SIII, at
the rectosigmoid
junction.
• Retroperitoneal
position

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

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

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(1) TEETH

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 (2) TONGUE

• The anterior part is triangular in

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

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MUSCLE OF THE TONGUE
• Extrinsic muscle, originate outside of the
tongue and insert to the tongue:
– genioglossus, hyoglossus, styloglossus &
palatoglossus muscles
• Intrinsic muscle, originate and insert
within the tongue:
– superior & inferior longitudinal,
transverse & vertical muscles.
– Function: alter the shape of the tongue:
lengthening & shortening; curling &
uncurling its apex and edges; flattening &
rounding its surface.

INNERVATION

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SALIVARY GLANDS

• Opens into oral cavity

• Divide into: intrinsic &
extrinsic salivary glands
• Intrinsic salivary glands:
– glands of tongue,
palate, lips, dan pipi
• Extrinsic glands:
– parotid,
submandibular, and
sublingual glands

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PAROTID GLAND

• The parotid duct

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

• It open into oral

cavity adjacent to
the crown of upper
molar 2

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 SUBMANDIBULAR & SUBLINGUAL
GLANDS

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

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 LIVER

• Location: right
hypochondrium &
epigastric region or right
upper quadrant
• Surfaces:
– Diaphragmatic surface:
anterior, superior &
posterior direction
– Visceral surface: inferior
direction. Covered by
visceral peritoneum
except in the fossa for
gallbladder & at the porta
hepatis.
• The porta hepatis consist
of: hepatic artery proper,
portal vein, hepatic duct

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• Lobes: divided into left & right
lobes by the gallbladder &
inferior vena cava. Includes
caudate lobe on the upper
part and quadrate lobe on the
lower part of liver.
• Ligaments:
– Falcicorm lig.: attach the
liver to the anterior
abdominal wall
– Round ligament of liver:
degeneration of umbilical
vein
– Triangular lig.( left & right):
attach the liver to the
diaphragm
– Coronary lig.( anterior &
posterior): attach the liver to
the diaphragm
– Hepatogastric lig: connect
the liver-stomach
– Hepatoduodenal lig: connect
the liver-duodenum
• Bare area of liver: an area (The right colic flexure & colic transverse)
between the liver &
diaphragm which is devoid of
peritoneum.
• Relation to other organs.
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 GALLBLADDER
Parts of gallbladder:
• Fundus: may project
from the inferior border
of liver
• Body of gallbladder.
• Neck of gallbladder.
• Duct: cystic duct
• Hepatic duct & cystic
duct open to common
bile duct (ductus
coledochus) and
drains to descending
part of duodenum.

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

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

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 PANCREAS

Tail

Body

Head

• Pancreatic ducts:
– Major pancreatic duct : begins in the tail of the pancreas. The main pancreatic duct
join the bile duct and forms the papilla of Vater, which enters the descending part of
the duodenum at the major duodenal papilla of Vater.

– Minor pancreatic duct: drains into the duodenum, above the major duodenal papilla
at the minor duodenal papilla 50
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BLOOD SUPPLIES

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 ARTERIAL SUPPLY OF THE GASTROINTESTINAL
VISCERA & ASSOCIATED ORGANS

The gastrointestinal viscera and associated organs are supplied by the

anterior branches of the abdominal aorta.
• Celiac artery (celiac trunk): branches from the abdominal aorta below the
aortic opening (at the upper border of vertebra LI) and supplies foregut
derivatives.
– abdominal part of esophagus, stomach, upper 1 ½ parts of duodenum up to
duodenal papilla of Vater, liver, common bile duct, pancreas, spleen
• Superior mesenteric artery: branches from the abdominal aorta at the
lower border of vertebra LI and supply midgut derivatives.
– Lower 2 ½ part of duodenum below the duodenal papilla of Vater, jejunum,
ileum, cecum, appendix , ascending colon, right of 2/3 transverse colon
• Inferior mesenteric artery: branches from the abdominal aorta at
approximately vertebral level LIII and suplies hindgut derivatives.
– Left of 1/3 transverse colon ,descending colon, sigmoid colon, rectum, upper
part of the anal canal above the pectinate line.
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 ANTERIOR BRANCHES OF THE ABDOMINAL AORTA

Superior mesenteric
artery
Celiac trunk
Celiac trunk
Superior mesenteric
artery
Abdominal aorta FOREGUT
Inferior mesenteric artery

AORTA ABDOMINALIS

MIDGUT

HINDGUT

Inferior mesenteric artery

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 CELIAC ARTERY (CELIAC TRUNK): BRANCHES
Left gastric artery:
• Run downwards along the lesser curvature.
• Branches: esophageal & gastric branches

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

Common hepatic artery:

– Right gastric artery: run along the lesser curvature
– Hepatic artery proper. Near the porta hepatis it divides into:
• right & left hepatic artery
– Gastroduodenal artery. Downward to duodenum. Branches:
• Supraduodenal artery
• Right gastro-omental (gastroepiploic) artery: run along the greater curvature of the
stomach
• Superior pancreaticoduodenal artery: supplies the head of the pancreas and the54 54
duodenum.
 Left gastric artery

Splenic artery

Celiac
Common hepatic artery
trunk

CELIAC TRUNK AND ITS BRANCHES 55

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SPLENIC ARTERY AND ITS BRANCHES

Short gastric artery

Gastro-omenta
(Gastroepiploic) artery

Splenic artery

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COMMON HEPATIC ARTERY & ITS BRANCHES

Right hepatic artery

Left hepatic artery

Proper hepatic artery

Gastroduodenal artery
Common hepatic artery

Right heparic artery

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 SUPERIOR MESENTERIC ARTERY
• Crossed anteriorly by the splenic vein & the neck of
pancreas.
• Posterior to the artery: left renal vein, uncinate process
of the pancreas & inferior (horizontal) part of the
duodenum
• Branches:
– Inferior pancreaticoduodenal artery: the head of the pancreas & the
duodenum
– Intestines arteries ] jejunal & ileai arteries
– Ileocolic artery ] colic, cecal & appendicular branch
– Right colic artery : the ascending colon & the right flexure colon
– Middle colic artery: right 2/3 of the transverse colon

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 SUPERIOR MESENTERIC ARTERY
& ITS BRANCHES

MIDDLE COLIC ARTERY

INFERIOR PANCREATICODUODENAL ARTERY
SUPERIOR MESENTERIC ARTERY

RIGHT COLIC ARTERY JEJUNUM

JEJUNAL ARTERIES

ILEOCOLIC
ARTERY

ILEAL ARTERIES

APPENDICULAR ARTERIES

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

• Sigmoid arteries: supplies the lowest part of the descending colon

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

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

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INFERIOR MESENTERIC ARTERY
& ITS BRANCHES

RIGHT COLIC ARTERY

INFERIOR MESENTERIC ARTERY

SUPERIOR RECTAL ARTERY

SIGMOID ARTERIES

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 VENOUS DRAINAGE
OF THE GASTROINTESTINAL VISCERA &
ASSOCIATED ORGANS
• Venous drainage from the spleen, pancreas, gallbladder, and the
abdominal part of the gastrointestinal tract (except for the inferior
part of the rectum)

PORTAL VEIN

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 PORTAL VEIN

• Venous blood from stomach, duodenum, jejunum, ileum

colon, rectum, pancreas, gallbladder & spleen enters the
liver through hepatic portal vein  sinusoids of liver 
hepatic veins  drains into inferior vena cava  enters
the right atrium of the heart.

• Formed by the union of the splenic vein & superior

mesenteric vein, at the level of the vertebra LII.

• Course: passed posterior to the superior part of the

duodenum & enters the hepatic portal vein with the bile
duct & proper hepatic artery.

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 PORTAL VEIN

PORTAL
VEIN

SPLENIC VEIN
INFERIOR MESENTERIC VEIN
SUPERIOR MESENTERIC VEIN

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VENOUS DRAINAGE OF THE ABDOMINAL PORTION OF THE
GASTROINTESTINAL TRACT

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 PORTOCAVAL SYSTEM
• Anastomosis (communication) between portal vein (portal system) with
the vena cava (caval system).
• Forms collateral circulation in portal obstruction.
• Important sites:
– Abdominal part of the esophagus:
• esophageal tributaries of the left gastric vein (portal) with esophageal
tributaries of the azygos & hemiazygos veins (systemic)
– Umbilicus
• paraumbilical veins (portal) & epigastric veins (systemic)
– Bare area of liver
• hepatic venules (portal) with the intercostal veins & phrenic vein
(systemic)
– Posterior abdominal wall
• Veins of retroperitoneal organs (portal) with the retroperitoneal veins of
the abdominal wall & the renal capsule (systemic)
– Anal canal
• superior rectal vein (portal) with the middle rectal & inferior rectal veins
(systemic)
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 PORTOCAVAL SYSTEM
Tributaries to azygos vein

V. PORTA

ROUND LIG. (LIG. TERES HEPATIS)

&.PARAUMBICAL VEINS

Superficial veins on
abdominal wall
INFERIOR VENA CAVA

SUPERIOR RECTAL VEIN

INFERIOR RECTAL VIEN

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 PORTOCAVAL SYSTEM

• Portal vein obstruction  portal hypertension

• Caput medusae  at the umbilicus
• Esophageal varices  at the gastroesophageal
junction
• Haemorrhoids  at the anorectal junction

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

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

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

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

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

• Gastric nodes ] lies along lesser curvature. Receive lymph from the
esophagus, lesser curvature, posterior-anterior-inferior aspect of the
stomach.
• Hepatic nodes ] lies with hepatic artery. Receive lymph from the
stomach, duodenum, liver, gallbladder & pancreas.
• Pancreaticosplenic nodes ] lies along splenic artery. Receive
lymph from stomach, spleen & pancreas.
• Mesenteric nodes ] lies along superior mesenteric artery. Receive
lymph from the jejunum & ileum (except from the terminal ileum)
• Ileocolic nodes ] lies along ileocolic artery. Receive lymph from
the terminal ileum, appendix, cecum, ascending colon.
• Transverse mesocolic nodes ] between transverse mesocolon.
Receive lymph from the transverse, descending & sigmoid colon.

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 INNERVATION

Parasymphatetic :
• Increase peristaltic movement
• Increase secretion of the digestive glands

Symphatetic :
• Inhibitory to peristalsis
• Increase contraction of the sphincter muscle

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 PARASYMPHATETIC SYMPHATETIC

Constricts pupil Stimulates tear glands

Inhibits tear glands Dilates pupil

Inhibits salivation,
Increases salivation increases sweating

Accelerates heart
Slows heart

Dilates bronchi
Constricts bronchi

Decreases digestive
functions of
stomach
Increases digestive
function of stomach Secretes adrenalin

Decreases digestive
Increases digestive
function of function of
intestine
intestine

Inhibits bladder
Contracts bladder contraction 72
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 Biomedical and Clinical Anatomy
1. Describe the nerves involved in taste !
2. What is the relationship between the lingual nerve and the
submandibular duct?
3. Why is m.genioglossus importance in maintaining an airway in the
unconcious patient?
4. Why might a patient with carcinoma of the tongue complain a
severe earache?
5. When someone has ill, why all the food taste bitter?
6. Which potentially weak regions of the anterior abdominal wall are
sites for herniae?
7. What anatomical differences are there between an indirect and
direct inguinal hernia?

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8. Why is the pain of early appencitis generalised and paraumbilical in site,
whereas later on in the course of the disease it is localised to the right iliac
fossa?
9. Explain the physical examamination of appendicitis correlate with anatomy!
(rovsing sign, psoas sign and obturator sign)
10. Describe the vascularisation of gaster, pancreas and liver!
11. How would you distinguish between jejunum and ileum?
12. What are the distinguishing features of the large intestine compared to the
small intestine?
13. Why might a patient with a cancer of the stomach present with obstructed
pancreatic drainage?
14. Which region of the large bowel is most likely to suffer from ischemia and why?
15. Why should a cancer of the head of the pancreas cause a patient to be
jaundiced?

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16. Describe the most common arrangement in the formation of the
portal vein!
17. Where are the main site of postosystemic venous anastomoses?
18. Why must the patient hold his breath during liver biopsy?
19. What is the embryological explanation of an emperforate anus?
20. In performing a rectal examination on male or female, what
stucture might normally feel?
21. Why may haemorroids be associated with cirrhosis of the liver
and if injected in the correct region, cause no pain?

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

THANK YOU…
SEE YOU IN THE LAB. PRACTICE
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 “Maka hendaklah manusia memperhatikan makanannya”
(QS Abasa 24)

“Dia telah menciptakan sesuatu dan Dia juga menetapkan ukurannya

dengan serapi-rapinya”
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(QS al Furqaan: 2)