digestive glands peritoneum. glands of the digestive tube glandulae salivariae = salivary glands...
TRANSCRIPT
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Digestive Digestive glandsglandsPeritoneum
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Glands of the digestive tubeGlands of the digestive tube
• glandulae salivariae = salivary glands
• pancreas
• hepar = liver
• vesica fellea + ductus choledochus = gallbladder + bile duct
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Glandulae orisGlandulae orisglandulae 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)
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Glandulae salivariae majoresGlandulae 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
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Glandulae salivariae - cellsGlandulae 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
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Glandulae salivariae - cellsGlandulae salivariae - cells• cells of intercalated
duct• simple flat / low cuboidal
epithelium• 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
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Glandulae salivariae
into intelobular ducts
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Glandula parotideaGlandula 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
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Glandula parotidea - Glandula parotidea - structurestructure
• pure serous, compound acinar gland
• ramified acines, long ducts• plasmocytes in lamina propria - IgA
complexes with secretory component (synthetized in serous, intercalated and striated parts)
• PAS+ granule (polysacharids, amylase)
• 25% of saliva volume
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Glandula submandibularisGlandula 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
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Glandula submandibularis - Glandula submandibularis - structurestructure
• 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
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Glandula sublingualisGlandula sublingualis
• ductus sublingualis major Bartholini caruncula sublingualis
• ductus sublinguales minores plicae sublinguales
innervation: identical with glandula submandibularis
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Glandula sublingualis - Glandula sublingualis - structurestructure
• seromucous, compound tubulo-acinar gland
• mucous cells prevail
• no intercalated ducts
• short striated ducts
• 5% of saliva volume
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PancreasPancreas• 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
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PancreasPancreas – – arterial supplyarterial supplycaput:• 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
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Pancreas Pancreas – – other supplyother supplyveins:• 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.
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PancreasPancreas – – mixed glandmixed 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, HCO 3
-, neutralization of chymus
• cholecystokinin much enzymes (realease of granules)
• pars endocrinna – insulae pancreaticae = islets of Langerhans
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PancreasPancreas – – pars exocrinnapars exocrinna
acines surrounded with BM
1 – exocrinne cells of pancreas (pancreatocytus exocrinus)– zymogen granula
2 – centroacinar cells (cellula centroacinosa)
3 – intercalated duct (ductus intercalatus)
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Hepar = Liver
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regiohypochondriaca
dextra
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Liver - Liver - descriptiondescription
• 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
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Liver - Liver - SegmentsSegments• 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
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Liver classification (Claude Couinaud 1957)Liver classification (Claude Couinaud 1957) SegmentumSegmentum
Pars hepatis sinistra
Divisio lateralis sinistra
Segmentum posterius laterale sinistrum II
Segmentum anterius laterale sinistrum III
Divisio medialis sinistra
Segmentum mediale sinistrum IV
Pars posterior hepatis; Lobus caudatus
Segmentum posterius; Lobus caudatus Spigeli
I
Pars hepatis dextra
Divisio medialis dextra
Segmentum anterius mediale dextrum V
Segmentum posterius mediale dextrum VIII
Divisio lateralis dextra
Segmentum anterius laterale dextrum VI
Segmentum posterius laterale dextrum VII
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Segmenta Segmenta hepatishepatis
• borders by vv. hepaticae
• lobus caudatus = segmentum I
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Bismuth‘s clasification
(USA)
• 4 sectors
• 8 segments
• Segmentum IV– IVa– IVb
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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.
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Liver - Liver - facies visceralisfacies visceralis• Porta hepatis• Fissura lig. venosi, fissura lig. teretis• Sulcus venae cavae• Fossa vesicae biliaris
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Porta hepatisPorta hepatis
v. porta dorsal
a. hepatica propria
r. dx. et sin. ventromedial
ductus hepaticus dx. et sin
ventrolateral
lymph vessels nerve plexus
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Liver Liver blood supply – blood supply – 2 circulations2 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.
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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 !!!)
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Liver - Liver - structurestructure
• tunica fibrosa Glissoni
• hepatocytes– lamina hepatocytica = trabecules of hepatocytes– spatium perisinusoiodeum = Disse‘s space– sinusoides in 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
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HepatocyteHepatocyte• polyhedric• oeosinophilic• large spheroid
nucleus– can be
polyploid• GER + SER mitochondria
• bile canaliculus• tight junction• microvilli• Disse‘s space• endothelium
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Classical hepatic lobuleClassical hepatic lobuleLobulus hepaticus classicus = polygonalisLobulus hepaticus classicus = polygonalis
• Weppler 1665• 3 zones
– central III– intermediate II– peripheral I
• structural unit of liver parenchyma
• hexagonal shape• v. centralis• hepatocytes in radiate
trabecules• spatium portale• blood flows from the periphery
to the centre
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• portal triad (trias hepatica)– venula ( v. portae), PV– arteriola ( a. hepatica), A– interlobular bile duct (
ductus hepaticus), B• simple cuboidal epithelium
perivascular fibrous capsulespace of Malllymph capillaries
• portal lobule (lobulus portalis)– centre = portal triad
PPortortal al area/canal/zone area/canal/zone ((spatium portalespatium portale))
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Liver acinus of Rappaport
Acinus hepaticus
• rhomboid• functional unit • according to blood
supply (preterminal branch of hepatic arteriole)
• 3 zones– selective damage of
hepatocytes
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Spatium portale (PA):branch of a. hepatica
bile ductule
branch of portal vein
Classical hepatic lobule
Liver acinus
Portal lobule
Central vein (CV)
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Liver - Liver - functionfunction• synthesis of proteins
– continuous release into blood– albumin, fibrinogen, protrombin, transferrin,
lipoproteins...
• secretion of bile– water, ions, bile acids, phospholipids, cholesterol,
bilirubin
• metabolic– accumulation of metabolits: TAG, glycogen, vit. A– gluconeogenesis, glycogenolysis, deamination of
AA– detoxication: oxidation, methylation, conjugation
• hemopoiesis– during development
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Bile ductsBile ductsDuctus biliferiDuctus biliferi
• intrahepatic:
canaliculus bilifer canalis
bilifer of Hering
ductus bilifer interlobularis • extrahepatic:
ductus hepaticus dx. et sin. d.h. communis connection with d. cysticus d. choledochus (m. sphincter d. ch.) ampulla hepatopancreatica (m. sphincter a. h. Oddi) papilla duodeni major Vateri duodenum
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Ductus choledochus
• pars supraduodenalis
• pars retroduodenalis
• pars pancreatica
• pars intramuralis
• ampulla hepatopancreatica (77 %)
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Vesica fellea/biliaris = GallbladderVesica fellea/biliaris = Gallbladder
• description: fundus, corpus, infundibulum, collum, ductus cysticus (plica spiralis Heisteri)
• arteries: truncus coeliacus a. hepatica communis a. hepatica propria, r. dx. a. cystica
• veins correspond to arteries
v. portae• lymph: n.l. hepatici• trigonum cystohepaticum Caloti• intraperitoneal organ
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Gallbladder - Gallbladder - structurestructure• tunica mucosa
– simple columnar epithelium– frequent folds– missing lamina musuclaris mucosae– collum – mucosal glands– pouches of mucosa into muscle layer (Aschoff-Rokitansky‘s sinuses)
• no tunica mucosa• tunica muscularis
– plexiform; cholecystokinin + ANS contraction
• tunica serosa– thick tela subserosa– tunica adventitia: largely sessile to liver in fossa vesicae biliaris
• function: – accumulation and concentration of bile (reabsorption of water to 10%)– 30-50 ml
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Bile ducts - Bile ducts - structurestructure
• simple columnar epithelium– cholangiocytes– scattered goblet cells
• glandulae ductus choledochi – mucinous• wall made of connective tissue predominatly• missing continuous muscle layer
• thin wall can be easily compressed → jaundice
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