Digestive system Glands and peritoneum Glands of the

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 Úglandulae salivariae majores – gl. parotidea (parotid gland) – gl. sublingualis (sublingual gland) – gl. submandibularis (submandibular gland) Úglandulae salivariae minores Úbuccales, molares, labiales, palatinae, linguales anterior (Blandini = Nuhni), posterior (gustatoriae Ebneri, radicis linguae Weberi)

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

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

Glandulae 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

Glandulae salivariae into intelobular ducts

Glandula parotidea • ductus parotideus Stenoni above upper M 2 • 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

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

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

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

Glandula sublingualis • ductus sublingualis major Bartholini caruncula sublingualis • ductus sublinguales minores plicae sublinguales innervation: identical with glandula submandibularis

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

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 L 2, secondary retroperitoneal organ

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 L 2, sekundárně retroperitoneálně

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

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.

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, HCO 3 -, neutralization of chymus • cholecystokinin much enzymes (realease of granules) • pars endocrinna – insulae pancreaticae = islets of Langerhans

Pancreas – pars exocrinna acines surrounded with BM 1 – exocrinne cells of pancreas (pancreatocytus exocrinus) – zymogen granula 2 – centroacinar cells (cellula centroacinosa) 3 – intercalated duct (ductus intercalatus)

Hepar = Liver

regio hypochondriaca dextra

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

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

Liver classification (Claude Couinaud 1957) Segmentum 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 Segmentum posterius mediale dextrum V VIII Divisio lateralis dextra Segmentum anterius laterale dextrum VI Segmentum posterius laterale dextrum VII

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

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

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.

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

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

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.

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 !!!)

Liver - structure • 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

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

Classical hepatic lobule Lobulus 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

Portal area/canal/zone (spatium portale) • 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

Liver acinus of Rappaport Acinus hepaticus • rhomboid • functional unit • according to blood supply (preterminal branch of hepatic arteriole) • 3 zones – selective damage of hepatocytes

Spatium portale (PA): Liver acinus branch of a. hepatica bile ductule branch of portal vein Classical hepatic lobule Portal lobule Central vein (CV)

Liver - function • 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

Bile ducts Ductus 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

Ductus choledochus • • • pars supraduodenalis pars retroduodenalis pars pancreatica pars intramuralis ampulla hepatopancreatica (77 %)

Vesica 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

Gallbladder - structure • 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

Bile ducts - structure • 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