1 PART Ⅱ SPLANCHNOLOGY 内脏学

2 Chapter 1 General description 总 论 Splanchnology includes alimentary system 消化系统, respiratory system 呼吸系统, urinary system 泌尿系统 genital system 生殖系统

3 Ⅰ.General structure of viscera The organs of viscera may be divided into two types according to their general structures: hollow organs( 中空性器官 ) ; parenchymatous organs( 实质性器官 )

4 Ⅰ.General structure of viscera 1. Hollow organs 中空性器官 The wall of these organs consists of three or four layers of different tissues. (1)mucosa 黏膜 ; (2)submucosa 黏膜下层 ; (3)muscular layer 肌层 ; (4)adventitia 外膜

5 Ⅰ.General structure of viscera (1) This kind of organs are commonly enclose by thin fibrous capsule 纤维囊 and divided into manyunits known as lobules 小叶 ; (2) Hilum or porta 门 : a somewhat depression or slit on the surface of organ, where the blood vessle, nerve and lymphatic enter or leave the organ. 2. Parenchymatous organs 实质性器官 Porta hepatis 肝门

6 一、 The reference line of thorax 胸部的标志线 1.Anterior median line 前正中线 2.Lateral sternal line 胸骨线 3.Midclavicular line 锁骨中线 4.Parasternal line 胸骨旁线 5.Anterior axillary line 腋前线 6.Midaxillary line 腋中线 7.Posterior axillary line 腋后线 8.Scapular line 肩胛线 9.Posterior median line 后正中线 Ⅱ The reference line of thorax and abdominal region

7 transtubercular line subcostal line midinguinal line 1.Nine-area method 九分法 Reference line: transtubercular line 结节间线 subcostal line 肋下线 midinguinal line 腹股沟中线 Nine regions Epigastric region 腹上区 Umbilical region 脐区 Hypogastric region 腹下区 Right and left hypochondriac region 左右季肋区 lateral region(lumbar region) 外侧区 ( 腰区 ) inguinal region(iliac region) 腹股沟区 ( 髂区 ) 二、 Abdonminal regions 腹部分区

8 2. Quadrants 四分法 The quadrants is made by the planes, a transverse and a vertical,which pass through the umbilicus and intersec at right angle,so the abdomen is divided into four quadrants: Upper right quadrant(RUQ) 右上腹 Upper left quadrant(LUQ) 左上腹 Lower right quadrant(RLQ) 右下腹 Lower left quadrant(LLQ) 左下腹 RUQ LUQ LLQ RLQ 二、 Abdonminal regions 腹部分区

9 Chapter 2. alimentary system 消 化 系 统

10 Mouth 口腔 Pharynx 咽 Esophagus 食管 Stomach 胃 Small intestine 小肠 Large intestine 大肠 Digestive glands 消化腺 Superior digestive tube 上消化道 Inferior digestive tube 下消化道 Major salivary glands 大唾液腺 Liver 肝 Pancreas 胰 Function : ingestion, digestion, absorption, egesting Digestive tube 消化管 Duodenum 十二指肠 Jejunum 空肠 Ileum 回肠 Cecum 盲肠， Vermiform appendix 阑尾、 Colon 结肠， rectum 直肠、 Anal canal 肛管 Composition

11 一、 oral cavity 口腔 （二） cheek 颊 （三） palate 腭 Hard palate 硬腭 Soft palate 软腭 Uvula 腭垂 palatine Velum 腭帆 Palatoglossal arch 腭舌弓 Palatopharyngeal arch 腭咽弓 硬腭 软腭 腭垂 腭舌弓 腭咽弓 （一） oral lips 口唇 : oral fissure 口裂 oral vestibule 口腔前庭 oral cavity proper 固有口腔 借上下牙弓分为 : 第一节 alimentary canal 消化管

12 腭垂 Uvula 腭垂 Palatoglossal arch 腭舌弓 Root of tongue 舌根 Free border of soft palatine Isthmus of fauces 咽峡

13 1 、 shape of teeth Crown 牙冠 : Projecting above the gum and to be seen ; Root 牙根 : In the jaw. Neck 牙颈 : Between the crown and root and covered by gum; 每个牙根有 apical foramen 根尖孔 apical foramen root canal 牙龈牙龈 pulp chamber pulp chamber 牙冠腔。 root canal 牙根管 牙根管与牙冠腔合称牙腔 dental cavity 或 髓腔 pulp cavity ， contains dental pulp 牙髓 。 （四） teeth 牙

14 2 、 the structure of the teeth ： 3 、 periodontal tissues 牙周组织 : 包括 Dentine Enamel Cement Gingiva alveolar bone periodontal membrane periodontal membrane 牙周膜、 alveolar bone 牙槽骨、 Gingiva 牙龈 Dentine 牙质、 Enamel 釉质、 Cement 牙骨质、 dental pulp 牙髓 dental pulp （四） teeth 牙

15 （ 1 ） kinds of teeth deciduous teeth 乳牙： 20 permanent teeth 恒牙： 、牙的种类和排列

16 Upper jaw Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ Lower jaw Ten teeth in each mandibular and maxillary arch Central incisor 中切牙, lateral incisor 侧切牙, canine 尖牙, first molar 第一磨牙 and second molar 第二磨牙 in each quadrant lateral incisor canine first molar second molar Central incisor Deciduous teeth 乳牙 : 20 in number

17 Sixteen in each mandibular and maxillary arch Two incisors （ Central incisor 中切牙, lateral incisor 侧切牙） one canine, two premolars （ first and secon premolarmolar ） three molars （ first ， second and third molar ） Upper jaw Lower jaw Ⅲ 表示左上颌第 二前磨牙 表示右下颌第三 颗乳牙 - 乳尖牙 Permanent teeth (adult) 恒牙 : 32 in number

18 1 、 shape of tongue 2 、 Lingual mucous membrane 舌粘膜 （ 1 ） papillae of tongue 舌乳头 filiform papillae 丝状乳头 fungiform papillae 菌状乳头 foliate papillae 叶状乳头 vallate papillae 轮廓乳头 （ 2 ） lingual tonsil 舌扁桃体 舌根背部粘膜内，由淋巴组织组成的突起。 Terminal sulcus 舌盲孔 filiform papillae fungiform papillae foliate papillae vallate papillae lingual tonsil superrior （ dorsum of tongue 舌背） Inferior 下面 Body 舌体 Root 舌根 Apex 舌尖 ( 五 ) tongue 舌

19 Frenulum of tongue 舌系带 下颌下腺管及舌 下腺大管开口 Sublingual gland 舌下腺 sublingual caruncle 舌下阜 sublingual fold 舌下襞 2 ）舌下面

20 intrinsic muscles 舌固有肌 extrinsic muscles 舌外肌 Longitudinal m. 纵肌 Transverse m. 横肌 Vertical m. 垂直肌 genioglossus 颏舌肌 Actions: 两侧同时收缩， 伸舌 ( protrude the tongue ) ；单侧收缩，伸 舌时舌尖偏向对侧。 上纵肌 舌垂直肌 下纵肌 颏舌肌 舌横肌 舌垂直肌 Origin: mental spine of mandible; Insertion: 舌的中线两侧。 3 、 Muscles of tongue 舌肌

21 Minor salivary glands 小唾液腺 ：唇腺、颊腺、腭腺和舌腺等 Major salivary glands 大唾液腺 1 、 parotid gland 腮腺 Deep part 深部 Superficial part 浅部 : parotid duct 腮腺管 passes forwards across masseter m. and then turns inwards passing through the buccinator m. 颊肌 to open upon a small papilla on the cheek mucous membrane opposite the crown of the second upper molar tooth 开口于与上颌第二磨牙牙冠相 对的颊粘膜上 腮腺 masseter buccinator parotid duct 包括： parotid gland 、 submandibular gland 和 sublingual gland 舌下腺 （六） Salivary glands 口腔腺

22 3 、 sublingual gland 舌下腺 下颌下腺 舌下襞舌下襞 major sublingual duct--- sublingual caruncle 舌下阜 minor sublingual duct— sublingual fold 舌下襞 Lies in the submandibular triangle 颌下三角内， its duct opens into the sublingual caruncle 舌下阜 2 、 submandibular gland 下颌下腺

23 （一） nasopharynx 介于颅底与腭帆后缘平面之间， 与鼻腔相通。 咽扁桃体 pharyngeal tonsil. 咽鼓管咽口 pharyngeal opening of auditory tube ， 距下鼻甲后端约 1cm ， 通中耳鼓室。 咽鼓管圆枕 tubal torus 、 咽隐窝 pharyngeal recess 咽腔分别以软腭与会厌上缘为界， 分为 : nasopharynx 鼻咽、 oropharynx 口咽 laryngopharynx 喉咽 咽鼓管咽口 咽鼓管圆枕 咽隐窝 二、 pharanx 咽

24 介于腭帆后缘至会厌上缘平面之间，经咽峡 isthmus of fauces 与口腔相通 Anterior wall ： 舌根后部 median glossoepiglotic fold 舌会厌正中襞 epiglottic vallecula 会厌谷 Lateral wall ： palatine tonsil 腭扁桃体 tonsillar fossa 扁桃体窝 舌会厌正中襞会厌 谷 ( 二 ) oropharynx 口咽

25 pharyngeal tonsile 咽扁桃体、 tubal tonsile 咽鼓管扁桃体、 palatine tonsile 腭扁桃体 lingual tonsile 舌扁桃体， Functuion ： defend and protection tonsillar ring of pharynx 咽淋巴环

26 位于会厌上缘至第六颈椎体 下缘平面之间，经喉口与喉 腔相通。 piriform recess 梨状隐窝 : 喉的两侧和甲状软骨内 面之间的粘膜下陷形成。 ( 三 ) laryngopharynx 喉咽

27 （一） position and division （二） narrows of the esophagus: position distance from middle incisor first beginning 15cm second front of left branchi 25cm third esophageal hiatus 40cm three parts: Cervical parts ： 5cm; Thoracic parts: cm; Abdominal parts:only 1-2cm. three narrows : 三、 Esophagus 食管

28 胃是消化管最膨大的部分，上连食管，下续十二指肠。 （一） position cardia pylorus mostly lies in the left hypochondriac region 左季肋区 and lesser part lie in the epigastric region 腹上区. （二） shape and division shape ： 胃有上下两口、 前后两壁和大小两弯。 Cardia 贲门 Pylorus 幽门 Two opening ： 四、 Stomach 胃

29 Two wall Anterior wall Posterior wall 4 parts : cardiac part 贲门 ; fundus of stomach 胃底, body of stomach 胃体 ; Pyloric canal pyloric part 幽门部 Pyloric canal 幽门管 Pyloric antrum 幽门窦 fundus of stomach body of stomach cardiac part Lesser curvature of stomach Greater curvature of stomach Two curvature Lesser curvature of stomach 胃小弯 Greater curvature of stomach 胃大弯

30 Cardia pylorus Lesser curvature Greater curvature 贲门切迹 fundus body Pyloric part 幽门部 Pyloric antrum Pyloric canal

31 － consists of four layers Mucous membrane 黏膜 Submucous 黏膜下层 ( loose areolar tissue connecting the mucous and muscular layer) Muscular layer 肌层 : contains –superficial longitudinal frbres –middle circular fibres Sphincter of pylorus 幽门括约肌 Pyloric valve 幽门瓣 –Inner oblique fibres Serous (visceral peritoneum) 浆膜 层 Structure of stomach wall

32 （一） duodenum 十二指肠 1 、 superior part 十二指肠上曲 sup erior duodenal flexure 十二指肠球部 duodenal bulb About 5-7m long, Divided into  Duodenum 十二指肠  Jejunum 空肠  Ilium 回肠 五、 small intestine 小肠

33 3 、 horizontal part 水平部 4 、 ascending part 升部 suspensory lig.of duodenum 十二指肠悬韧带 : 又称 Treitz 韧带, ，是辨认 空肠起端的标志。 duodenojejunal flexure 十二指肠空肠曲 inferior duodenal flexure 十二指肠下曲 Major duodenal papilla 十二指肠大乳头 longitudinal fold of duodenum 十二指肠纵襞 2 、 descending part 降部

34 Jejunum 空肠 and ilium 回肠 T he jejunum and ileum lies free in the abdomen. They are attached to the posterior abdominal wall by the mesentery 系肠膜. Their total length is approximately 5~7 metres ， The upper 2/5 of it is called jejunum 空肠 and lower 3/5 is called ileum 回肠.the terminal part of the ileum open to the large intestine 。

35 CharacteristicJejunumIleum PositionUpper 2/5Lower 3/5 DiameterGreaterLess WallThickerThin Circular foldsLarger, numerous and large villi Fewer ， smaller and less abundant villi VascularityGreaterLess ColourDeeper redPaler Lymphatic follicles SolitaryAggregated Jejunum and ileum

36 Approximately 1.5m long, Five parts: –Cecum 盲肠 –Vermiform appendix 阑尾 –Colon 结肠 –Rectum 直肠 –Canal 肛管 六、 large intestine 大肠

37 colic bands 结肠带 由肠壁的纵行肌增厚而成，有 3 条，汇集 于阑尾根部。 haustra of colon 结肠袋 epiploic appendices 肠脂垂 两袋之间为横沟，结肠内面，相当 于横沟处，环形肌增厚，形成结肠 半月襞。 colic bands haustra of colon epiploic appendices 结肠半月襞 Features ：

38 first part of large intestine, Lies in right iliac fossa The ilium enters the cecum obliquely, and partially invaginates into it, forming the ileocecal valve 回盲瓣－ consists of two folds. ileocec al valve （一） Cecum 盲肠

39 阑尾孔阑尾 is a narrow blind tube, usually 6 ~ 8cm long. It opens into the caecum 盲肠。 position: very variable in position, frequently lies in the retrocaecal recess 盲肠后窝 or extend into the lesser pelvis 小骨盆. （ 二） vermiform appendix 阑尾

40 The surface projection (McBurney’s point) of the base of appendix 阑尾体表投 影 ： is the junction of the lateral and middle thirds of the line joining the right anterior superior iliac spine to the umbilicus 脐. The base of the appendix lies at the point of convergence of three colic bands (used as a guide to find the appendix during operation) Appendix 阑尾

41 在右髂窝内续于 cecum 盲肠，在 第 3 骶椎平面连接 rectum 直肠，呈 “M” 形包围小肠， 1 、 asccending colon 升结肠 2 、 transverse colon 横结肠 3 、 descending colon 降结肠 4 、 sigmoid colon 乙状结肠 right colic flexure 结肠右曲 left colic flexure 结肠左曲 由横结肠系膜连于腹后 壁，活动度较大。 借乙状结肠系膜连于骨 盆侧壁，活动度较大。 （三） colon 结肠

42 位于小骨盆腔的后 部、骶骨的前方 Sacral flexure of rectum 骶曲 Perineal flexure of rectum 会阴曲 1 、 position: 2 、 Two flexure 3 、 ampulla 直肠壶腹 4. three transverse folds of rectum 直肠横襞，中间的直肠横襞最大，位置 最恒定，位于直肠右壁，距肛门约 7cm 。 骶曲 会阴曲 直肠壶腹 直肠横襞 肛管 直肠壶腹 ( 四 ) rectum 直肠

43 1 、 position: 上端在盆膈平面接直肠，下 端终于 anus 肛门，长约 4cm 。 肛柱肛瓣肛窦肛梳 白线 2 、 struture ： anal columns 肛柱 anal valves 肛瓣 anal sinus 肛窦 Dentate line 齿状线 anal pecten 肛梳（痔环） （五） anal canal 肛管

44 3 、 sphincters of anus 肛门括约肌 Sphincter ani internus 肛门内括约肌 Sphincter ani externus 肛门外括约肌 Anorectal ring 肛直肠环： 由肛门外括约肌浅深部、直肠纵 肌下份、肛内括约肌以及肛提肌 等组成。 （五） anal canal 肛管

45 The liver is divided into a large right lobe 右叶 and a small left lobe 左叶 by the falciform ligament 镰状韧带 which is attached to the superior surface of the liver to the anterior abdominal wall. right lobe left lobe 镰状韧带 liver 肝 The liver is the largest digestive gland, lies mainly in the right hypochondrium and epigastric region of the abdominal cavity below the right half of the diaphragm, lesser part of it lies in the left hypochondrium region..

46 superior surface is smooth and curved, and fits into the diagphragm. at the posterior part of the surface,A large part of which is not covered by the peritonium is called the bare area 肝裸区. superior surface (diaphragmatic surface) 上面或膈面

47 inferior surface （ visceral surface ）下面或 脏面 There are 3 fissures arranged like “H”: left longitudinal fissure 左纵沟 right longitudinal fissure 右纵沟 transverse sulcus— porta hepatis 肝门

48 right longitudinal fissure 左纵沟 ant: Fissure for ligamentum teres 肝圆韧带裂 post: Fissure for ligamentum venosum 静脉韧 带裂 右纵沟 Ant: fossa for gall-bladde 胆囊窝 Post: sulcue for inferior vena cava 腔静脉沟 left longitudinal fissure

49 right and left branches of the hepatic artery 肝固有动脉左右支 right and left hepatic ducts 肝左右管 hepatic portal vein 肝门静脉左右支 lymphatics 淋巴管 Nerves 神经 supplying the liver. contains The structures passing through the porta hepatis is inclosed by connective tissues form the Hepatic padicle 肝蒂 porta hepatis 肝门

50 Anterior ( inferior) margin 前缘 : is sharp, posterior marge 后缘 : Right margin 右缘 Lfet margin 左缘 The fundus of the Gallbladder 胆囊底 Protude below the Inferior margin of the Liver at the notch for Gallbladde 胆囊切迹. The liver has 4 borders:

51 left lobe 左叶. Left to the left longitudinal fissure right lobe 右叶. right to right longitudinal fissure caudate lobe 尾状叶. Behint the porta hepatis quadrate lobe 方叶. anterior to the porta hepatis 左叶 右叶 方叶 尾状叶. In the inferior surface, the liver may be divided into 4 lobes:

52 Upper border: on the right midclavicular line it extends to the level of 5th rib Lower border: Normally, the right lobe extends just beneath the costal margin, it doesn’t down beyond the costal margin; on the anterior median line its lower border crosses a point about 3~5cm below the xiphoid process. In children, the liver may extends cm below the costal arch. Surface projection of the liver

53 The gallbladder and biliary ducts It consists of the fundus 底, body 体, neck 颈, and the duct of gallbladder 胆 囊管 4 parts. the fundus is the expanded anterior end of the organ and protruds below the inferior margin of the liver, it lies behind the point where the lateral margin of the right rectus abdominis meets the costal arch. 1 、 The gallbladder 胆囊

54 body of gallbladder ：胆囊体 neck of gallbladder ：胆囊颈 the cystic duct 胆囊管 is about 2cm in length, it joins the common hepatic duct to form the common bile duct.

55 Common bile duct 胆总管 The common bile duct descends first in the hepatoduodenal ligament 肝十二 指肠韧带, and then posterior to the superior part of the duodenum and the head of the pancreas 胰头. It enters the the descending part of the duodenum at its middle and open into its lumen via the greater duodenal papilla 十 二肠大乳头. The pancreatic duct 胰管 joins it during its passage through the duodenal wall to form the ampulla, which is called hepatopancreatic ampulla (of Vater) 肝胰壶腹.

56 sphincter of hepatopancreatic ampulla 肝胰壶腹括约肌 The sphincter of hepatopancreatic ampulla 肝胰壶腹括约肌 (Odis 括约肌 ) is layer circular muscle surrounding the ampulla of hepatopancreatic ampulla, it controls the flow of bile and pancreatic secretions into the duodenum. Obstruction of the biliary system results in the clinic condition of jaundice (yellow skin) 黄疸.

57 Pancreas 胰 Division : It may be divided into head, neck, body and tail 4 parts. head 胰头 lies in the concavity of the duodenum, anterior to the inferior vana cava. its inferomedial extension is clled uncinate process 钩突. Position: lies behind the peritoneum 腹膜 on the upper part of the posterior abdominal wall, roughly at the level of the L1~L2 vertebra.

58 pancreas 胰 Pancreatic ducts 胰管 it begins in the tail, runs through the body,neck and the head, usually it joins the common bile duct as it pierces the duodenal wall. body 胰体 lies anterior to the abdominal aorta and the left kidney, behind the stomach. tail 胰尾 may reach the hilus of the spleen. Accessory pancreatic duct 副胰管 十二肠小乳头

59 The function of the pancreas The pancreas has both exocrine 外分泌 and endocrine 内分泌 function. The exocrine part secretes a number of the different enzymes that break down proteins, carbohydrates,and fats. The endocrine part consists of minute islands(islets) 胰岛 of cells which secretes insulin 胰岛素 directly into the blood stream for the control of blood sugar level.

60 Bile is secreted by the liver cells Common hepatic duct when taking food, the gallbladder contracts, the sphincter of hepatopancreatic ampulla relax Common bile duct Major duodenal papilla Biliary ductuli Right and left hepatic ducts Gallbladder (store, concentrate) Cystic duct The place of bile secreted and path of bile discharged

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82 Cardia pylorus Lesser curvature Greater curvature 贲门切迹 fundus body Pyloric part 幽门部 Pyloric antrum Pyloric canal

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