内脏学 SPLANCHOLOGY

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

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)

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

Ⅰ.General structure of viscera 2. Parenchymatous organs实质性器官 (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.

Porta hepatis肝门

Ⅱ The reference line of thorax and abdominal region Anterior median line 前正中线 Lateral sternal line 胸骨线 Midclavicular line 锁骨中线 Parasternal line 胸骨旁线 Anterior axillary line 腋前线 Midaxillary line 腋中线 Posterior axillary line 腋后线 Scapular line 肩胛线 Posterior median line 后正中线

二、Abdonminal regions 腹部分区 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)

subcostal line midinguinal line transtubercular line

二、Abdonminal regions 腹部分区 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

消 化 系 统 Alimentary System

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

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

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

（四）teeth 牙 pulp chamber 1、shape of teeth Crown 牙冠: Projecting above the gum and to be seen ; 牙龈 Neck 牙颈: Between the crown and root and covered by gum; Root 牙根: In the jaw. root canal 每个牙根有apical foramen根尖孔 apical foramen root canal牙根管 pulp chamber牙冠腔。 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 2、the structure of the teeth： Dentine 牙质、 Enamel 釉质、 Gingiva Dentine Dentine 牙质、 Enamel 釉质、 Cement 牙骨质、 dental pulp 牙髓 dental pulp Cement 3、periodontal tissues 牙周组织: 包括 alveolar bone periodontal menbrane periodontal menbrane 牙周膜、 alveolar bone 牙槽骨、 Gingiva 牙龈

4、牙的种类和排列 （1）kinds of teeth deciduous teeth 乳牙：20 permanent teeth 恒牙： 28-32

Deciduous teeth 乳牙: 20 in number 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 Upper jaw Ⅰ Ⅱ Ⅲ Ⅳ Ⅴ Lower jaw lateral incisor canine first molar second Central

Permanent teeth (adult) 恒牙: 32 in number 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 1 2 3 4 5 6 7 8 Lower jaw 1 2 3 4 5 6 7 8 5 表示左上颌第二前磨牙 Ⅲ 表示右下颌第三颗乳牙-乳尖牙

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

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

3、 Muscles of tongue 舌肌 genioglossus 舌垂直肌 舌横肌 Longitudinal m.纵肌 intrinsic muscles 舌固有肌 Transverse m.横肌 Vertical m.垂直肌 extrinsic muscles 舌外肌 genioglossus 颏舌肌 Origin: mental spine of mandible; Insertion: 舌的中线两侧。 上纵肌 舌垂直肌 下纵肌 颏舌肌

（六） Salivary glands 口腔腺 Minor salivary glands 小唾液腺 包括： parotid gland、 submandibular gland和sublingual gland Major salivary glands 大唾液腺 parotid duct 1、 parotid gland 腮腺 Deep part 深部 buccinator 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

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

二、 pharanx 咽 咽腔分别以软腭与会厌上缘为界，分为: nasopharynx 鼻咽、 oropharynx 口咽 咽鼓管咽口 laryngopharynx 喉咽 咽鼓管咽口 咽鼓管圆枕 （一） nasopharynx 咽隐窝 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

(二) oropharynx 口咽 Lateral wall： palatine tonsil腭扁桃体 舌会厌正中襞 会厌谷 Lateral wall： palatine tonsil腭扁桃体 tonsillar fossa扁桃体窝 Anterior wall ： 舌根后部 median glossoepiglotic fold 舌会厌正中襞 epiglottic vallecula 会厌谷

tonsillar ring of pharynx 咽淋巴环 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

(三) laryngopharynx 喉咽 piriform recess 梨状隐窝 : 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、 Esophagus 食管 （一）position and division three parts: Cervical parts：5cm; Thoracic parts: 18-20 cm; Abdominal parts:only 1-2cm. （二）narrows of the esophagus: three narrows: position distance from middle inscior first beginning 15cm second front of left branchi 25cm third esophageal hiatus 40cm

四、 Stomach 胃 （二）shape and division shape：胃有上下两口、前后两壁和大小两弯。 （一）position （二）shape and division shape：胃有上下两口、前后两壁和大小两弯。 cardia Two opening ： Cardia 贲门 pylorus Pylorus 幽门

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

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

Structure of stomach wall －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

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

2、descending part 降部 inferior duodenal flexure 十二指肠下曲 longitudinal fold of duodenum 十二指肠纵襞 Major duodenal papilla 十二指肠大乳头 3、horizontal part 水平部 4、ascending part 升部 duodenojejunal flexure 十二指肠空肠曲 suspensory lig.of duodenum 十二指肠悬韧带

Jejunum 空肠 and ilium 回肠 The 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。

Jejunum and ileum Characteristic Jejunum Ileum Position Upper 2/5 Lower 3/5 Diameter Greater Less Wall Thicker Thin Circular folds Larger, numerous and large villi Fewer，smaller and less abundant villi Vascularity Colour Deeper red Paler Lymphatic follicles Solitary Aggregated

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

Features： colic bands 结肠带 haustra of colon 结肠袋 epiploic appendices 肠脂垂 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 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。 epiploic appendices 肠脂垂 haustra of colon colic bands 结肠半月襞 epiploic appendices

（一）Cecum盲肠 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. ileocecal valve

（二）vermiform appendix 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. 阑尾孔 阑尾

Appendix 阑尾 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.

（三）colon 结肠 2、transverse colon 横结肠 1、asccending colon升结肠 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

(四) rectum 直肠 1、position: 3、ampulla 直肠壶腹 2、 Two flexure Sacral flexure of rectum 骶曲 2、 Two flexure 4. three transverse folds of rectum Perineal flexure of rectum 会阴曲 骶曲 直肠壶腹 直肠横襞 直肠壶腹 会阴曲 肛管

（五）anal canal 肛管 1、position: 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） 肛柱 肛窦 肛瓣 肛梳 白线

（五）anal canal 肛管 3、sphincters of anus 肛门括约肌 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。 Sphincter ani internus肛门内括约肌 Sphincter ani externus 肛门外括约肌

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 . 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. left lobe right lobe 镰状韧带

superior surface (diaphragmatic surface)上面或膈面 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.

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

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

porta hepatis 肝门 contains 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 The structures passing through the porta hepatis is inclosed by connective tissues form the Hepatic padicle 肝蒂

The liver has 4 borders: 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.

In the inferior surface, the liver may be divided into 4 lobes: left lobe 左叶、 right lobe 右叶、 caudate lobe 尾状叶 、quadrate lobe 方叶 尾状叶. 左叶 右叶 方叶

Surface projection of the liver 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 1.5- 2cm below the costal arch.

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.

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.

Common bile duct 胆总管 The common bile duct descends first in the hepatoduodenal ligament, of the duodenum and the head and then posterior to the superior part of the pancreas. 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.

sphincter of hepatopancreatic ampulla 肝胰壶腹括约肌 The sphincter of hepatopancreatic ampulla 肝胰壶腹括约肌 is layer circular muscle surrounding the ampulla of hepatopancreatic ampulla, it controls the flow of bile and pancreatic secretions into the duodenum.

Pancreas 胰 Position: 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.

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. 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. Accessory pancreatic duct 副胰管 十二肠小乳头

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.

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

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