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Digestive system

Digestive system. Glands and peritoneum. Glands of the digestive tube. glandulae salivariae = salivary glands pancreas hepar = liver vesica fellea + ductus choledochus = gallbladder + bile duct. Glandulae oris. glandulae salivariae majores gl. parotidea (parotid gland)

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Digestive system

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  1. Digestive system Glands and peritoneum

  2. Glands of the digestive tube glandulae salivariae = salivary glands pancreas hepar = liver vesica fellea + ductus choledochus = gallbladder + bile duct

  3. Glandulae oris glandulae salivariae majores gl. parotidea (parotid gland) gl. sublingualis (sublingual gland) gl. submandibularis (submandibular gland) glandulae salivariae minores buccales, molares, labiales, palatinae, linguales anterior (Blandini = Nuhni), posterior (gustatoriae Ebneri, radicis linguae Weberi)

  4. Glandulae salivariae majores capsula(collagen fibres) septa secretory part serous, mucous and myoepithelial (basket) cells system of ducts intralobular intercalated striated excretory  interlobularinterlobar principaloral cavity

  5. Glandulae salivariae - cells serous cells acinus (pyramid shape) produce proteins basophillic, ER, GA microvilli apically, secretory granules mucous cells cuboidal, columnar form tubules produce mucus light granula (which can fuse) viscose secretion  more distally than serous cells

  6. Glandulae salivariae - cells cells of intercalated duct simple flat / low cuboidalepithelium lactoferin, lysozyme ductus intercalati converge in ductus striati cells of striated duct radial arrangement striation = fold of BM + mitochondria cells transporting ions form hypotonic saliva

  7. Glandulae salivariae into intelobular ducts

  8. Glandula parotidea ductus parotideus Stenoni  above upper M2 pars profunda, superficialis in between plexus intraparotideus n. VII glandula parotidea accessoria regio parotideomasseterica innervation: parasympathetic: n. IX  n. tympanicus  n. petrosus minor (Jacobson‘s anastomosis) ganglion oticum Arnoldi  n. auriculotemporalis sympathetic: truncus sympaticus  ggl. cervicale sup.  plexus a. meningeae mediae

  9. Glandula parotidea - structure pure serous, compound acinar gland ramified acines, long ducts plasmocytesin lamina propria - IgA  complexes with secretory component (synthetized in serous, intercalated and striated parts) PAS+ granule (polysacharids, amylase) 25% of saliva volume

  10. Glandula submandibularis ductus submandibularis Whartoni  caruncula sublingualis trigonum submandibulare innervation: parasympathetic: n. VII. chorda tympani  n. lingualis ganglion submandibulare sympathetic: truncus sympathicus  ggl. cervicale sup.  plexus a. facialis

  11. Glandula submandibularis - structure seromucous, compound tubulo-acinar gland serous acines adjacent to mucous tubules are transformed in serous demilunes (semiluna serosa – semiluna Giannuzzi-Heidenhain) serous elements prevail (basophilic cytoplasm) PAS+ granule 70% of saliva volume

  12. Glandula sublingualis ductus sublingualis major Bartholini  caruncula sublingualis ductus sublinguales minores  plicae sublinguales innervation: identical with glandula submandibularis

  13. Glandula sublingualis - structure seromucous, compound tubulo-acinar gland mucous cells prevail no intercalated ducts short striated ducts 5% of saliva volume

  14. Pancreas description: caput (processus uncinatus, incisura), collum, corpus (margines, facies), cauda structure: ductus pancreaticus Wirsungi (sphincter d.p.), d.p. accessorius Santorini insulae pancreaticae Langerhansi (1%) fixation: lig. pancreaticosplenicum, - colicum, vasa mesenterica sup. syntopy: duodenal window L2, secondary retroperitoneal organ

  15. Slinivka (břišní) = pancreas, micter • Popis: caput (processus uncinatus, incisura), collum, corpus (margines, facies), cauda • Stavba: ductus pancreaticus Wirsungi (sphincter d.p.), d.p. accessorius Santorini • Insulae pancreaticae Langerhansi (1%) • Fixace: lig. pancreaticosplenicum, - colicum, vasa mesenterica sup. • Syntopie: duodenální okénko L2, sekundárně retroperitoneálně

  16. Pancreas – arterial supply caput: truncus coeliacus a. hepatica communis  a. gastroduodenalis  a.pancreaticoduodenalis sup. post. + sup. ant. + aa. retroduodenales a. mesenterica sup.  a. pancreaticoduodenalis inf.  ramus ant. + r. post. corpus et cauda: truncus coeliacus a. splenica  rr. pancreatici

  17. Pancreas – other supply veins: vv. pancreaticoduodenales  v. mesenterica sup.  v. portae vv. pancreaticae  v. splenica  v. portae lymph drainage: n.l. pancreaticoduodenales, mesenterici sup.  n.l. lumbales nerves: parasympathetic – n. X sympathetic – truncus sympaticus  nn. splanchnici major + minor  ggl. coeliacum + mesentericum sup.

  18. Pancreas– mixed gland pars exocrinna – serous, compound tubulo-acinar gland serous cells (pancreatocytus exocrinus) form acines, ER, GA, granula zymogeni apically no striated intralobular ducts ductus intercalatus  d. intralobularis  d. interlobularis  d. excretorius  d. pancreaticus (+ d.p. accessorius) secretion: water, ions, (chymo-)trypsinogen, carboxypeptidase, (deoxy-)ribonuclase, lipase, amylase, elastase secretin  much fluid, HCO3 -, neutralization of chymus cholecystokinin  much enzymes (realease of granules) pars endocrinna – insulae pancreaticae = islets of Langerhans

  19. Pancreas – pars exocrinna acinessurrounded with BM 1– exocrinne cells of pancreas (pancreatocytus exocrinus) zymogengranula 2 – centroacinar cells (cellula centroacinosa) 3 – intercalated duct (ductus intercalatus)

  20. Hepar =Liver

  21. regio hypochondriaca dextra

  22. Liver - description facies diaphragmatica (area nuda, impressio cardiaca), visceralis (impression of organs - 6) margo inferior 4 lobes (descriptive) 8 segments (according to blod vessels branching) ligaments: lig. teres hepatis, venosum, coronarium /falciforme, triangulare dx. et sin., hepatorenale/, appendix fibrosa hepatis, lig. venae cavae fixation: suspended on v. cava inf., grows together with diaphragm, supported by other organs, lig. teres hepatis

  23. Liver - Segments • segment has in tis center: artery, veins (branch from v. portae, bile duct • vv. hepaticae are between segments ! • plane along v. hepatica media divides liver into lobus dx, et sin. • projects on surface as Rex-Cantlie‘s line (center of fossa vesicae feleae → v. cava inf.) • v. hepatica dx. divides right lobe into anterior (V+VI) and posterior segments (VII+VIII) • v. hepatica sin. dělí divides left lobe into lateral (II+III) and medial segments (IV) • clock-wise

  24. Segmenta hepatis • borders by vv. hepaticae • lobus caudatus = segmentum I

  25. Bismuth‘s clasification (USA) • 4 sectors • 8 segments • Segmentum IV • IVa • IVb

  26. Liver blood supply porta hepatis: v. portae, a. hepatica propria, ductus hepaticus dx. et sin., lymph vessels and nerves fissurae (3) + fossa vesicae felleae arteries: truncus coeliacusa. hepatica communis  a. hepatica propria (+ a. hepatica accessoria)  r. dx.+ sin.  aa. interlobulares veins: v. portae vv. interlobulares  capillaries  vv. centrales  v. hepaticae  v. cava inf.

  27. Liver - facies visceralis • Porta hepatis • Fissura lig. venosi, fissura lig. teretis • Sulcus venae cavae • Fossa vesicae biliaris

  28. Porta hepatis • v. porta • dorsal • a. hepatica propria • r. dx. et sin. • ventromedial • ductus hepaticus dx. et sin • ventrolateral • lymph vessels • nerve plexus

  29. Liver blood supply – 2 circulations • arteries: truncus coeliacusa. hepatica communis  a. hepatica propria (+ a. hepatica accessoria)  r. dx.+ sin.  aa. interlobulares • veins: v. portae vv. interlobulares  capillaries  vv. centrales  v. hepaticae (dx., media, sin.)  v. cava inf.

  30. Liver - lymph and nerves lymph: 3 directions n.l. coeliaci n.l. mediastinales ant. n.l. mediastinales post. nerves: parasympathetic – n. X sympathetic – truncus sympathicus  plexus coeliacus  plexus hepaticus viscerosensory – n. phrenicus (peritoneum under liver as far as gallbladder !!!)

  31. Liver - structure tunicafibrosa Glissoni hepatocytes lamina hepatocytica = trabecules of hepatocytes spatium perisinusoiodeum = Disse‘s space sinusoidesin between (= irregulary extended capillaries with fenestrated endothelium) von Kupffer´s cells = macrocytophagus stellatus Ito´s cells = cellulae perisinusoidalis (fat storing cell) production of collagen for trabecules, storage of vitamin A, canaliculus bilifer(bile canaliculus) – wall is formed directly by plasmalemma of hepatocytes

  32. Hepatocyte polyhedric oeosinophilic large spheroid nucleus can be polyploid GER + SER mitochondria bile canaliculus tight junction microvilli Disse‘s space endothelium

  33. Classical hepatic lobuleLobulus hepaticus classicus = polygonalis Weppler 1665 3 zones central III intermediate II peripheral I structural unit of liver parenchyma hexagonal shape v. centralis hepatocytesin radiate trabecules spatium portale blood flows from the periphery to the centre

  34. portal triad (trias hepatica) venula (v. portae), PV arteriola (a. hepatica), A interlobular bile duct (ductus hepaticus), B simple cuboidal epithelium perivascular fibrous capsule space of Mall lymph capillaries portal lobule (lobulus portalis) centre = portal triad Portal area/canal/zone (spatium portale)

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