Gastrointestinal System

Accessory organs

Assistant Prof. Tarek Abdelkader

Accessory organs of the digestive system

In this lecture we’ll discuss the following in details:

1. Oral cavity

2. Liver

3. Gall bladder

4. Pancreas

We’ll also talk about the spleen which is NOT a part of the digestive system.
 Oral cavity
• The roof is formed by the hard and soft palate

• The floor of the oral cavity is covered by thin and vascular layer of
mucosa supported by geniohyoid and mylohyoid muscles while the
tongue rests on it

• The lateral walls of oral cavity are supported by pads of fat and the
buccinator muscle.
Oral Cavity
Functions of Oral cavity

(1) Taste sensation.

(2) Grinding of food through the actions of the teeth, tongue, and palatal
surfaces.
(3) lubrication by mixing with mucus and saliva.
(4) limited digestion of carbohydrates and lipids.

To achieve these functions the major components of the oral cavity must act
together
• Teeth
• Tongue
• Salivary Glands
Parotid Sublingual Submandibular
Teeth

Gingivitis, Tooth
decay or caries
Gingivitis Tooth decay or caries
Tongue
 Tongue Filiform papillae

Circumvallate papillae
Fungiform papillae
 Tongue
functions of the tongue
(1) mechanical processing
(2) manipulation of food
(3) sensory analysis by
touch, temperature, and
taste receptors
(4) secretion of mucins and
the enzyme lingual lipase

Ankyloglossia, Tongue ulcers,

Tongue lesions and White
discoloration of the tongue
Salivary glands
 Salivary glands
Parotid salivary glands produce a serous secretion containing large amounts of salivary amylase. This enzyme breaks
down starch

Sublingual salivary glands are covered by the mucous membrane of the floor of the mouth. These glands produce a
mucous secretion that acts as a buffer and lubricant

Submandibular salivary glands lie along the inner surfaces of the mandible within a depression called the mandibular
groove. Cells of the submandibular glands secrete a mixture of buffers, glycoproteins called mucins, and salivary
amylase.

Saliva (70% Submandibular, 25% Parotid and 5% Sublingual)

Saliva is 99.4 % water & 0.6 % electrolytes (Na+, Cl−, and HCO3), buffers, glycoproteins, antibodies, enzymes, and waste
products.
The salivary glands produce 1.0–1.5 litres of saliva each day.
Functions of saliva:
 Lubricating and moistening food in the mouth and the oral cavity
 Dissolving chemicals that can stimulate the taste buds and provide sensory information about the food
 Beginning the digestion of complex carbohydrates before the food is swallowed (salivary amylase)

mumps
Mumps, Salivary duct obstruction
 Liver
The liver lies primarily in the right hypochondrium and epigastric region, extending into the left hypochondrium

Surfaces of the liver:

1. Diaphragmatic surface

lies against the inferior surface of the diaphragm. Two lobes can be seen from that surface, right and left lobe. This surface is
in close relations to the subphrenic and hepatorenal recesses

The subphrenic recess separates the diaphragmatic surface of the liver from the diaphragm and is divided into right and left
areas by the falciform ligament

The hepatorenal recess (Morison’s pouch) is a part of the peritoneal cavity on the right side between the liver and the right
kidney and right suprarenal gland.

2. Visceral surface

It is mostly covered with visceral peritoneum except in the fossa for the gallbladder and at the porta hepatis. Plus the right
and left lobes, caudate lobe can be seen on this surface near the superior border of the liver and quadrate lobe can be seen
near the inferior border as well.
Liver ligaments

They stabilize the liver in its place by attaching it to the surrounding structures
1. Falciform ligament

2. Coronary ligament (anterior and posterior)

3. Triangular ligaments (left and right)

4. Lesser omentum
Liver
• The porta hepatis serves as the point of entry into the liver for the hepatic
arteries and the portal vein, and the exit point for the hepatic ducts

• The liver has a special blood supply system as It receives arterial blood from
right & left hepatic arteries from the hepatic artery proper which is a branch
from celiac trunk
• It also receives venous blood from the hepatic portal vein for detoxification
• Three hepatic veins drain the liver into the inferior vena cava
• The hepatic lymph nodes, lying in the lesser omentum, are responsible for
draining the anterior part of the liver.
• The posterior part drains the lymph into the phrenic and posterior mediastinal
lymph nodes.

• The liver is innervated by hepatic plexus which contains both sympathetic and
parasympathetic nerve fibers
 Left Hepatic A

Celiac Trunk
Right Hepatic A

Proper Hepatic A

Common Hepatic A
 Right Hepatic V

Left Hepatic V

Left Hepatic Portal V

Intermediate
Hepatic V
Hepatic Portal V
Right Hepatic
Portal V
Main functions of the Liver

The liver is a very important organ in the body as it’s involved with more that 200 functions which can be categorized into
three main categories

1) Metabolic regulation
store iron, some lipids, and heavy metals, store and release glucose, store cholesterol and
engulf pathogens
1) Hematological regulation
Production of certain proteins for blood plasma, processing for use of its iron content, clearing
the blood of drugs and regulating blood clotting (like I fibrinogen, II prothrombin…)
1) Bile production.
Which helps carry away waste and break down fats in the small intestine during digestion

The functional unit of the liver is the liver lobule

Hepatitis, Alcoholism,
Portal hypertension,
Cirrhosis
 Jaundice

Ascites
 Gall bladder
It is present on the visceral surface of the right lobe of the liver, specifically, in a fossa between the right and quadrate
lobes.

It has three main parts:

1. Fundus of the gallbladder

It is the most rounded end, which may project from the inferior border of the liver.
2. Body of the gallbladder
The major part in the fossa, which may be against the transverse colon and the superior part of the duodenum.
3. Neck of the gallbladder
The narrow part with mucosal folds forming the spiral fold.

The gall bladder receives blood supply through the cystic artery which is a branch from the right hepatic artery and
drains into the cystic vein which empties into the right hepatic portal vein. While the lymph drains into the cystic lymph
nods.

The main function of gall bladder is to store and concentrate the bile synthesized in the liver
The Biliary Tree

 The bile is synthesized in the liver lobule.

 It is then collected into the bile canaliculi inside the liver lobule which empties into the bile duct
in the portal area.

 These converge together to form the right and left hepatic bile ducts which drain from the right
and left lobes of the liver respectively.

 The two hepatic ducts combine to form the common hepatic duct, which runs near the liver,
with the hepatic artery proper and portal vein in the free margin of the lesser omentum.

 The common hepatic duct is joined by the cystic duct from the gall bladder to form the bile duct.

 The bile duct continues to descend, passing posteriorly to the superior part of the duodenum
and through the head of the pancreas before joining with the pancreatic duct to enter the
descending part of the duodenum.
 Common hepatic A

Common hepatic duct

Cystic duct

Gall bladder

Hepatic portal
vein

Bill duct
Ultrasound showing stones in the gall
bladder
 Pancreas
The pancreas lies mostly posterior to the stomach.
It consists of four parts:

Head
It lies within the C-shaped concavity of the duodenum

Neck
Positioned anterior to the superior mesenteric vessels

Body
It is elongate and extends from the neck to the tail of the
pancreas

Tail
It passes between layers of the splenorenal ligament
Blood Supply
Greater pancreatic artery & dorsal pancreatic artery,
both from splenic artery.
superior and inferior pancreaticoduodenal
arteries which are branches of the gastroduodenal
artery

The superior mesenteric branches of the hepatic

portal vein drains the head of pancreas. The
pancreatic veins draining the rest of the pancreas
into the splenic vein.
There are two main functions of the pancreas

1. Endocrine function

To control the glucose level in blood > pancreatic islets (islets of Langerhans) secrete insulin
and glucagon into the bloodstream

2. Exocrine function

To help in digestion by secreting digestive enzymes > the acinar cells and the epithelial cells
that line the duct system, secrete pancreatic juice (an alkaline mixture of digestive enzymes,
water, and ions) into the small intestine.
 Spleen
• The spleen is NOT a part of digestive system and it develops as part of the vascular system in the
part of the dorsal mesentery

• It is located in the left hypochondrium, of the abdomen against the diaphragm, in the area of rib IX
to rib X

• The spleen is connected to the:

1. greater curvature of the stomach by the gastrosplenic ligament, which contains the short gastric
and gastro-omental vessels.
2. left kidney by the splenorenal ligament, which contains the splenic vessels.

• The spleen is surrounded by visceral peritoneum except in the area of the hilum.

• The splenic hilum is the entry point for the splenic vessels, and occasionally the tail of the pancreas
reaches this area.

• It receives blood supply from the splenic artery which gives five different branches allowing for
(subtotal splenectomy). It drains into the splenic vein then superior mesenteric vein.
Spleen
CT showing enlarged spleen (splenomegaly)

May occur in cases of leukemia, lymphoma and

certain infections
 Thank you
Sources:
Grays Anatomy for Students 3rd edition
Fundamentals of Anatomy & Physiology-Pearson
Visible Body; Human Anatomy Atlas