Structures of the Foregut The gastrointestinal tract can be divided into three parts; foregut, midgut and hindgut.

This terminology relates to its embryological development. During this session you will gain an overview of these 3 regions and study the structures of the foregut in detail. 1. Overview of the Primitive Gut Derivatives The gastrointestinal tract is divided into the foregut, midgut and hindgut, which relates to its embryonic development from the primitive gut tube. The arterial blood supply to the gastrointestinal tract is supplied by 3 main branches of the abdominal aorta. The organs of each region of the gut are supplied by a common branch. Complete the table below to summarise this information. Structures Foregut Pharynx, esophagus, stomach, proximal half of duodenum Blood supply Artery: Celiac trunk (branches from the abdominal aorta at the upper border of vertebra LI) Vein: Hepatic portal vein Midgut Distal half of duodenum; jejunum, Artery: Superior mesenteric artery (arises from the ileum, cecum, appendix, ascending abdominal aorta at the lower border of vertebra LI) colon, proximal (right) two-thirds of transverse colon Vein: Inferior mesenteric vein Artery: Inferior mesenteric artery (which branches from the abdominal aorta at approximately vertebral level LIII) Vein: Superior mesenteric vein

Hindgut Distal (left) one-third of transverse colon; descending colon, sigmoid colon, rectum, superior portion of anal canal

2. Anatomy of foregut structures The foregut extends from the lower part of the oesophagus to the 2nd part of the duodenum; it includes the liver, pancreas and spleen. Today we will study the structures of the foregut (excluding the oesophagus, liver, gall bladder and spleen which will be studied later). For convenience we will examine the whole of the duodenum. Examine the prosections showing the organs in-situ and the models and isolated specimens. Abdominal wall Review the muscles of the abdominal wall. Identify the falciform ligament as it extends between the liver and the anterior abdominal wall. The ligamentum teres should be seen in the free inferior border of the falciform ligament. What is the ligamentum teres?
The falciform ligament is a ligament that attaches the liver to the anterior body wall. It is a broad and thin anteroposterior peritoneal fold, falciform (Latin "sickle-shaped"), its base being directed downward and backward and its apex upward and backward. The falciform ligament droops down from the hilum of the liver.

The ligamentum teres is the obliterated fibrous remnant of the left umbilical vein of the fetus. It originates at the umbilicus. It passes superiorly in the free margin of the falciform ligament. From the inferior margin of the liver, it may join the left branch of the portal vein or it may be in continuity with the ligamentum venosum.

Visceral surface of the liver. A. Illustration

Abdominal organs in-situ Note the greater omentum. How extensive is it in your prosection?

Is there any evidence of the greater omentum having walled off areas of infection?

Stomach In which abdominal region/s is the stomach located? Left hypogastrium, Epigastrium and Umbilical Where do the lesser and greater omentum attach to the stomach? Greater omentum Peritoneal fold suspended from the greater curvature of the stomach Lesser omentum Joins the lesser curvature of the stomach

Identify the cardia, fundus, body, pylorus (antrum, canal & sphincter) and the greater and lesser curvatures. Feel and comment on the pyloric and cardiac sphincters.

Examine the rugae. What is their function? Internally, the stomach lining is composed of numerous gastric folds, or rugae. These gastric folds, which are observed only when the stomach is empty, allow the stomach to expand greatly when it fills and then return to its normal J-shape when it empties.

Where does lymph from the stomach drain to? The lymph vessels follow the artery into the left gastric node

Draw a simple diagram showing the blood supply of the stomach. Can you find any of the branches on the specimen? Blood supply to the stomach

Duodenum Examine the first part of the duodenum that extends from the pyloric region of the stomach. This part is suspended from the liver by the hepatoduodenal ligament and is intraperitoneal. The remainder of the duodenum is retroperitoneal. Peritoneal Relations It is retroperitoneal and fixed. Its anterior surface is covered with peritoneum, except in the median plane where it is crossed by superior mesenteric vessels and by the root of the mesentery.

Name and identify the four parts of the duodenum and state the artery that supplies each part. 1._Superior part, extends from the pyloric orifice of the stomach to the neck of the gallbladder, is just right of the body of vertebra L1 and passes anteriorly to the bile duct, gastroduodenal artery, portal vein and inferior vena cava -- supplied by branches derived from the celiac trunk (hepatic, right gastric supraduodenal, right gastoepiploic and superior panreatico-duodenal arteries) 2. Descending part, to the right of midline, its anterior surface is crossed by the transverse colon, posterior to it is the right kidney and medial to it is the head of the pancreas contains major duodenal papilla which is the common entrance for bile and pancreatic ducts and minor duodenal

papilla which is the entrance for the accessory pancreatic duct -- The upper part (supplied by branches derived from the celiac trunk (hepatic, right gastric supraduodenal, right gastoepiploic and superior panreatico-duodenal arteries)) 3. Horizontal part; begins at duodenal flexure where it is crossed by the superior mesenteric vessels and by the root of the mesentery -- Inferior pancreaticoduodenal branch of the superior mesenteric artery 4. Ascending part; passes upward or to let of aorta to approximately the upper border of vertebra L11 and terminates at the duodenojejunal flexure -- Inferior pancreaticoduodenal branch of the superior mesenteric artery

On the internal aspect of the duodenum find the minor and major duodenal papillae. What opens into the duodenum at each of these sites? Minor duodenal papilla Accessory pancreatic duct Major duodenal papilla Bile and pancreatic duct Note the arrangement and distribution of the plicae circulares. What is their function?

Unlike the folds in the stomach, they are permanent, and are not obliterated when the intestine is distended. The space between circular folds are smaller than the haustra of the colon, and, in contrast to haustra, circular folds reach around the whole circumference of the intestine. These differences can assist in distinguishing the small intestine from the colon on an abdominal x-ray.

Distribution They are not found at the commencement of the duodenum, but begin to appear about 2.5 or 5 cm. beyond the pylorus. In the lower part of the descending portion, below the point where the bile and pancreatic ducts enter the small intestine, they are very large and closely approximated. In the horizontal and ascending portions of the duodenum and upper half of the jejunum they are large and numerous, but from this point, down to the middle of the ileum, they diminish considerably in size. In the lower part of the ileum they almost entirely disappear; hence the comparative thinness of this portion of the intestine, as compared with the duodenum and jejunum. Function The circular folds slow the passage of the food along the intestines, and afford an increased surface for absorption. They are covered with small fingerlike projections called villi (singular, villus). Each villus, in turn, is covered with microvilli. The microvilli absorb fats and nutrients from the chyme.

Pancreas Is the pancreas an intraperitoneal or retroperitoneal organ? Retroperitoneal Examine the specimen to determine the relations of the pancreas. Anterior Stomach and duodenum Posterior Ucinate process, left kidney, Aorta and Vena Cava Identify the head, neck, body and tail of the pancreas. Note that the head of the pancreas lies in the curve of the duodenum and its tail extends towards the spleen.

Find the main and accessory pancreatic ducts. What part of the pancreas is drained by the duct system? The simple cuboidal epithelial cells lining the pancreatic ducts secrete bicarbonate (alkaline fluid) to help neutralize the acidic chyme arriving in the duodenum from the stomach. Most of the pancreatic juice travels through ducts that merge to form the main pancreatic duct, which drains into the major duodenal papilla in the duodenum. A smaller accessory pancreatic duct drains a small amount of pancreatic juice into a minor duodenal papilla in the duodenum .

Where are the endocrine cells of the pancreas located? Scattered amongst the pancreatic acini are small clusters of cells called pancreatic islets (islets of Langerhans). They number in millions but forms only 1% of the pancreatic volume.

Which vessels provide the blood supply to the pancreas?

The arterial supply to the pancreas (Fig. 4.101) includes the: gastroduodenal artery from the common hepatic artery (a branch of the celiac trunk); anterior superior pancreaticoduodenal artery from the gastroduodenal artery; posterior superior pancreaticoduodenal artery from the gastroduodenal artery; dorsal pancreatic artery from the inferior pancreatic artery (a branch of the splenic artery); great pancreatic artery from the inferior pancreatic artery (a branch of the splenic artery); dorsal pancreatic and greater pancreatic arteries (branches of the splenic artery); anterior inferior pancreaticoduodenal artery from the inferior pancreaticoduodenal artery (a branch of the superior mesenteric artery); and posterior inferior pancreaticoduodenal artery from the inferior pancreaticoduodenal artery (a branch of the superior mesenteric artery).