sheet 39 ::: the final one ::: edited :)

---The final anatomy sheet----
*In the name of Allah*

SPLEEN

What is the spleen ??
- its largest lymphoid gland in the body

Where is it?
It is located in the left hypochondriac region
Sheltered below left dum of diaphragm

It has three function:
1. storing your extra R.B.Cs
2.storing the old (worn-out) R.B.S
3. important for immunity.


Note: it is a completely intraperitoneal organ , except at its hilum.

Now let us have a glance on its parts :

It has the following parts :

2 surfaces : (1) convex diaphragmatic surface related to the left 9th , 10th , 11th Ribs
- with its axis parallel to left tenth rib -

) Concave visceral surface related to the stomach


2 Poles : (1) upper pole
(2) lower pole


please see page 2..

2 Borders : (1) superior border ( notched )
(2) inferior border ( sharp , smooth)


what about its arterial supply and venus drainage ???

Arterial supply ----> splenic artery (which is a branch from ciliac artery )

Venus drainage ----> Splenic vein ( which end at the portal vein )


Do know, my dear colleague ,that the Spleen follow the [ all or none ] rule !
That means that when its ruptured it should be removed , because if not it will cause a huge internal bleeding..


That’s enough about the spleen ….. lets talk briefly about pancreas




Pancreas


Little notes :
- acompound retroperitoneal endocrine and exocrine gland ( about 15 cm )
- comma-shaped extending from the 2nd of duodenum to the hilum of spleen
- located in the epigastric and left hypochondriac regions.


Has the following part :

1- HEAD : within concavity of the dudenum , received common and accessory pancreatic duct , bile duct course from behind !
2 -NECK : having the portal vein located behind it

please see page 3…..
3 - BODY : logest part , triangular in C.S splenic vein passing behind it
Splenic artery passing superior to it.

We said before that it is an endocrine and an exocrine gland at the same time.…..

Endocrine part : with in islets of langerhands : secreting 2 hormones :
1. Insulin : lowering the suger level in the blood
2. glucagon: elevating the suger level in the blood
Exocrine part :pancreatic duct : secrete to 2nd part of dudenum by :
- main pancreatic duct - accessory pancereatic duct

4 - TAIL : located at the hilum of spleen


good note : in future when you have a patient you should lay him/her on his/her back this is called “ supine ( recompetent) position “
**********************************






First you should all meet Nerdoosh ! He is an expert at embryology and he is helping us out with the last embryo sheet !!

Nerdoosh : before I start I feel I should straighten out a couple of things !

1-Blast : Original
2-Cyst: Sac
1+2 = BLASTOYCYST = ORIGINAL SAC

3-Mere : Subdivision
1+3= Blastomere = ORIGINAL SUBDIVISION


And with this my lecture shall begin !

This is a Continuation of the series of events of day 13 :

By the end of the second week the blastocyst is completely implanted and the endometrial implantation defect is healed .

Bleeding might occur occasionally !

Nerdoosh : it is around the 28th day of the lady's menstrual cycle !
14, ovulation day + ~ 13 days of pregnancy = 28!!!!!


Cellular columns from Cytotrophoblast invade the Syncytiotrophoblast forming the Primary Villi which is the beginning of placenta.

** I think you should start concentrating! New stuff starts here!


Primary villi will form secondary villi and then tertiary villi which is the final form of placenta.

At this time the intercommunication between the embryo – embryonic blood to be specific – and its mother's blood starts . However ,this communication is not complete ! Both are separated by a highly selectively permeable membrane.

*Nerdoosh : This permeable membrane is selective ! Not all that comes into mommy's blood will pass through… Nutrients are an exception and unfortunately so are the viral particles of measles and AIDS.

** :) If you guys just take a look at the hand out of this lecture you will notice something called "Connecting stalk" , this stalk forms the umbilical cord later on ! :) **


Once the embryo enters its third week , at day 15 , Gastrulation occurs .

Nerdoosh : Gastrulation is a process during which the morphology of the embryo is restructured by cell migration . It will change from a Bilaminar embryonic disk into a Trilaminar embryonic disk.

** You might want to take a look at your hand outs :) **

*Rapid development marks the beginning of the embryonic period : 3rd week – 8th week

*********************

Gastrulation explained!

1-At the beginning of the 3rd week a narrow line called the primitive streak is formed at the middle of the still Bilaminar embryonic disk.

2-Epiblast from the periphery will migrate towards the primitive streak, forming an elevation or a groove called "primitive groove".
3- Some of the migrating epiblast cells will migrate downward in the groove forming mesoderm ( it is between epiblast and hypoblast )
4-some will go down further to replace the hypoblast and give endoderm
5- Remaining cells will replace the epiblast and form the ectoderm. And with this the embryo is Trilaminar :)

Nardoosh: at this point I think we all arrived at the same conclusion! All body layers are derived from the epiblast!!

· Each layer is responsible for the formation of certain organs during the embryonic development.
1- Ectoderm: Nervous system + Epidermis of the skin.
2- Endoderm: Endothelial lining of digestive system, respiratory system etc.
3- Mesoderm: muscles, tendons, ligaments, bones, cartilage & blood vessels !

Nardoosh: Mesoderm is obviously the most important layer of all 3 layers ( AKA: germ layers ) .

With this I shall bid you farewell and leave room for Wa3d's and 3attili's longest dedication ever! Those 2 are breaking the record of the longest dedication written in the history of sheet writing if there is such a thing !



We, wa3d w 3abdelra7man , hope that we introduced a understandable and easy-to-study sheet :)

We feel obliged to thank Dr. Maher Hadidi for all the effort he exerted in teaching this course :)

We also wish you people the best grades in this course and future ones … Inshallah we will all make amazing doctors in the future ! Just remember: If you are going through hell , keep going on ! ** WE DIDN'T MAKE IT UP , SUM1 REALLY SAID THAT ! **


AND Finally we want to dedicate this sheet to our beloved friends and to all our colleagues in this faculty……

Shu r2yak 3attili nebda bel ladies be ma eno ladies first ?

Zein Najada ( eta oshkot ) , Haya Qudah ( finally a dedication … Yeppieeeee w 3attili b7gezlik el marah ele jay ! ) , Jamila 7iesat ( a7la ta7yeh la sokan jomhoriet al sal6 al sha8i8a ) , Suzan Mbydeen ( sum people r still waiting 4 that mansaf gurl ) , As7ar Tarawna , ala2 7jazi , Shatha 3attili ( 3ala rasi che guevara ) Dania Dahmash , Bayan 5door,saja 3r3r , Suzan Momani , Ruba al mu7taseb , Lamoosh jamal , Sawsan tabaza , Sondos al 5ateeb , Elham Qudah (dedication ^2 :P) , Batoul 3toom , Nadine 3adayleh , , Dana mel7em Tamara Darweesh , raya 7alawani , magd 5adr, amal 7osban ,Manar Jwainat , Fara7 mashagbeh , 3abeer 5watra, samar 68a68a , muna talal ( 3al 3afyeh:P) , ala2 jabre ( el m63m mo elhm :) ) , dana 6awalbieh ,Samar al ra7meh , nisreen abu 3osbeh , rawan 3'azal , rasha jabra , ala2 3abid, jeelan , suzan al musa , Isra2 zawawi , dina 3ammari , aya bani kinana , rozana ziadat , asma , lana 7adadin , ruba halaseh, dina ramini , razan abu dieh , rawan ( lovek 4 taking psycho :D ) ,ala2 7laisi, aseel abu shanab , du3a2 jara7 , du3a2 abu jame3, aseel al sayed ,dima , nadia ,rawan sale7,nuha, ,yasmeen el so5on , anne nimri !!

And with no further delay, the guys :

Ahmed el isa ,(abuel3ss) , ,fr7an el kooz ( jovial ) ,) wa2el 6o8an (alf mabrook:P) , ayyoub (yellow smile ), , 5alid 7gair (4-2-4) , m7md abu hanieh ( abu gor3a ;) , w aseem samara ( kasha6a),shaker borhm , hammam realat , m7md shawaf ( 3a rasi kol el i6allieh )fadi halaseh, yezan 3tom( ml7 3l sala6a) , martin qaqesh(kef el shbab) , bashar el rama7i , 3omar el lozzi ( neshfat el mae) , nidal matani (no visa,no league, no thing :D), 3’aleb 5rfan , 7amzeh 9araiera , m2moon sha3ban (ma bnnsak) , yazeed neef , abu 7alaweh , mo2ayad kettane ,sami 3abdeen , a7mad 3abed, 3amer 7ajaj,m7md saree3 , m7md maslamani , Bandar maslamani, 7amzeh jassar ( elsalam la allah ;p) , m7md el sboo3 , 7amzeh 9bai7 , , rami yagi, hashim abu m7fooz, zain rostom ( 3ala rasi walla) , nemer sh5shier , 3mr el 5alili , 3esa 38el , zaid 8ndeel, 3omar dodeen , bashar sharma ,7anna barghoth , tamimi ,8osai abu 3azzam , zaidon , 3bdelr7man el 56eeb , m7md 3’naem (pre-sheet), mostafa aburahmeh , a7mad abu 5adegieh, , m7md 8awasme , abu qamar , abu d3aig ( allah be3en 3l basa6 ), a7mad shalabe , el shareef , 3omar radaiedeh , yazan radaideh ( m5drat ) , , laith 7addad , osama , yazeeed 8aesieh , waleed 8adre , osama farrogeh ( farrogte) , mohanned ( ya 7abibi la t3eed wrae) ,A7mad 7orani ( hay dedication 3ashan ma t7ke 3an el sheet tb3tna!)

Ma azon nsena 7ada… :P

Wa 5etamoha mesk m3 wa3d Sweilmyeen w 3bdelra7man 3attili :D ….
Best wishes..

---WE LOVE YOU ALL, THANK YOU ALL---

Note:- organic final exam will be from (3:00-5:00) PM
-islamic culture final exam will be on 4/6/2008 at 11:30 in IT

** Corrections are in purple bold...becareful !!

sheet no.38

sheet6بعد النجاح الباهر الذي حققته

و بعد تزايد الطلب من كثير من الطلبة على تكرار التجربة فقد عزمنا و بسم الله نبدأ

Accessory digestive glands:

(1) LIVER:

- It is the largest gland in the body.
- It is located in the:
* Right hypochondriac region.
* Epigastric region.
* May extend to left hypochondriac region.
- It weighs about 1.5 kg.
- In newborn it represents about 10% of weight because it produces RBCs.
- In adults it weighs about 2% of their weight.
- Before birth and until the 3rd month we depend on liver in the production process of RBCs and that is why it represents 10% of newborn weight.
- It is completely an intraperitoneal organ except for 3 areas.

#Divisions:

- Divided into: - Right lobe (large)
- Left lobe (small)
by falciform ligament (c-shaped) "الرباط المنجلي" which is a double layer of Peritoneum between anterior abdominal wall and liver.
- At the free margin of falciform ligament there located ligamentum teres (الرباط الدائري) which was containing umbilical vein.

#Shape:

* From anterior view it is triangular in shape with:
- Superior border.
- Right border.
- Inferior border.
To look nearly like “La Vache qui rit” .

* The inferior border divides the liver into 2 surfaces:
1- Diaphragmatic surface: which is large and convex.
2- Visceral surface: which is concave.
* Below visceral surface we have the right kidney, that is why the right kidney is lower in position than left one, and right lung is higher than the left one due to the large mass of the liver.

-At visceral surface there is an H-shaped area formed by the following:
* right limb of the “H” formed by:
- inferior vena cava (superior).
- Gallbladder (inferior).
* left limb formed by:
- inferior fissure (for ligamentum teres).
- superior fissure (for ligamentum venosus).
* cross bar formed by:
- porta hepatis (the umbilicus of the liver) which contains the hepatic duct, hepatic artery, portal vein. (the duct is anterior / the artery is itermedial / the vein is posterior)


- Since the liver at the visceral surface has an H-shaped area it is divided into 4 lobes:

(1) Right lobe.
(2) Left lobe.
(3) Caudate lobe:
Boundaries:
- inferior: porta hepatis.
- superior: superior border.
- right: inferior vena cava.
- left: fissure for ligamentum venosum.

(4) Quadrate:
Boundries:
- inferior: inferior border.
- superior: porta hepatis.
- right: gallbladder.
- left: ligamentum teres.


- Functionally quadrate + cudate lobes are parts of the left lobe according to arterial supply, venous drainage and bile secretion.



#Arterial and venous supply of the liver:
1- Hepatic artery (branch from celiac artery) brings about 20% of blood to the liver itself.
2- Portal vein brings about 80% of deoxygenated blood from digestive tract for filtration and detoxication.

#The liver is completely intraperitoneal except for 3 retroperetorial parts:
1- Port hepatis.
2- Between Gallbladder and right lobe of the liver.
3- Bare area of the liver at superior border between liver and diaphragm. (important in cancer and from there the disease can go to the posterior mediastinum.

#Pain from liver is usually felt in right side, epigastric region.
- You should differentiate between pain from stomach and the pain from liver:
If the pain is coming from right side and going up towards the right lung >> then the problem is in the right lobe. (left lung > left lobe)

#Function:
· Main function of the liver is filtration.
· Other important functions:
1- Pile formation and secretion (for fat digestion)
2- RBCs’ formation in the embryo and the first three months after birth.
3- Detoxification (e.g. after drinking alcohol)
4- Storage of glycogen.
5- Important in blood clotting. (if we have a patient with تليف الكبد then the healing of the bleeding will be not easy)

(2) GALLBLADDER:

- Elongated pear-shaped sac.
- Close to the visceral surface of the right lobe of the liver.
- Normal capacity: 30 ml.
- Function: Storage and concentration of bile for about 10 times.
- Parts:

1) Fundus:
- Projects beyond inferior border of the liver.
- Completely intraperitoneal.
- Located below the tip of the right 9th rib.
- If the patient has a pain in the tip of the right 9th rib region then we should think of inflammation of Gallbladder which is called (colisitisis)

2) Body:
- The largest part.
- concentration area.

3) Neck.

4) Cystic duct
(قناة الحويصلة) which unites
with common hepatic
duct to form the common bile duct. (cystic duct + common hepatic duct = common bile duct)

- Arterial supply of Gallbladder is through a branch of celiac artery.

اخيرا و ليس اخرا اود ان اهنئ جميع زملائي بالدفعة بمناسبة انتهاء الفصل الثاني من السنة الاولى فلم يبق الكثير (هانت كلهم 16 فصل:D)

و اتمنى للجميع التوفيق في امتحاناتهم و دراسة ممتعة للجميع :) ولو اردت ذكر جميع الاخيار(او الشطار) لاحتجت الى مئات الجدران و لكني اذكر من تذكرت (فأحلى تحية لكل الشباب

وبما انها الsheet

قبل الاخيرة فحبيت اتذكر اكبر قدر ممكن و اخص بالذكر:

Razan 3moosh (w hay awal wa7adeh betmoni :P) , YAZAN 3TOOM , 3bdelra7man 3attili , Far7an Elkooz , Martin Qaqish , 3’aleb 5erfan , Wa2el 6o8an, Yasmine Elsukhon , Aseel Zein Eddin , 7amzeh Sarayra , Raya 7alawani , M7mmd 3arabeyyat , Zaid 8endeel , Elham El8dah , Dina 3mmari , Bandar Maslamani ,Ayoub 3ennabi, M7mmd Maslamani , Muna Talal , Samar Taqatqa , Fadi Halaseh , M7mmd Abu 5alaf , M7mmd Shawaf Qtaishat , Hammam Ryalat , Sami 3abdeen , A7mad 3abed , 3omar Abu Gamar , Rami Salameh , Ayman D3ja , Yazeed 8ayseyyeh , Osama , 7amzeh Jassar , Ma2moon Sha3ban , A7mad Abu 7alaweh , Yazeed Elnaif , 5aled 7ajir , Mo2ayyad Kettaneh , Yousef Kettaneh , Feras Elnemer , Walid El8adiri , Yazan Radaydeh , 3omar Radaydeh , Dana 6walbeh , A7mad 7ara7sheh , 3omar Ellowzi , Bashar Elrama7i , Bashar Sharma , 7amzeh Sbai7 , 3bdallah Tayyem , M7mmd Elmomani , Shatha El3attili , Amr El5alili , Tamara Darweesh , M7mmd Fadel , Zakareyya , Bilal Abu Dhaim , M7mmd Abu Haneyyeh , Waseem Samara , Shaker Barham , A7mad Elshalabi , Ala2 Jabri , Noorhan , 3amer 7ajjaj , Zain El3abedeen , Nemer Sha5sheer , Nidal Matani , 3eesa 3a8eel , M7mmd 8awasmi , Majd 5ader , Amal 7osban , 3omar Dodin , Zaid Shmaisani , 7anna Bar3’oot, Mus6afa Abu Ra7meh & for all Jubilians :D

best wishes;

A7mad El3eesa

sheet no.37

Notes for the last lecture:

-Outer cell (trophoblast) mass is nutritious.

-blastocyst cavity is the pool that allows the embryo to grow the way he wants freely.



Implantation


-Pregnancy starts when the Blastocyst loosely attached to the endometrium at Day 6(from fertilization)---->anchored implantation.

-Trophoblastic cells above inner cell mass attached to uterine wall by invading its epithelium and underlying stroma.



-At Day 7 implanted Blastocyst interrupted the regular sexual cycle affected by hCG hormone production from trophoblastic cells of the implanted Blastocyst.

*hCG---> (human Chorionic Gonadotropin)

-Chorion: Fetal portion of placenta.

-Gonad : sex organ (ovary here).

This hormone prevents degeneration of corpus luteum (C.L.)--->in the first 3 months, and maintains it as C.L. of pregnancy.

*Remember that C.L. will degenerate at Day 28 (from ovulation) and become corpus Albicans if no fertilization occurs.

-So we can detect pregnancy at Day 7.



At Day 8:

The trophoblastic cells differentiate into 2 layers:

Inner layer: Cytotrophoblast (mononucleated distinct cells).
Outer layer: Syncytiotrophoblast (multinucleated protoplasmic mass lacking cells) which is highly energetic.
Both 2 layers become part of the chorion.



The inner cell mass (Embryoblast) differentiates into 2 layers:

1- Hypoblast (with cuboidal cells) àendoderm to be.

2-Epiblast (with columnar cells) àectoderm to be.

Both layers form the Bilaminar embryonic disc.

A small cavity appears within epiblast then enlarges to be the Amniotic cavity.

Notes:

-The embryo has 3 layers:

Ectoderm (outermost).
Mesoderm (middle).
Endoderm (innermost).


-In Day 8 it will forms 2 layers & 2 cavities (Weak 2 loves no. 2).

-Until now there is no complete implantation.



Day 9:


Notice that:

-Syncytiotrophoblast will spread around(beldozer).

-Blastocyt embedded deeply in endometrium.

-Sycytium show small fluid-filled cavities (vacuoles)àfuseàto form trophoblastic lacunae.

* Lacunae mean---->cavities / small lakes.


Days 11 & 12:---->complete implantation


Trophoblastic lacunae fused to form lacunar network which communicate with maternal sinusoids to establish the Uteroplacental circulation which is the first communication between the mother & the embryo.



Day 13:


It has 3 main events:

Endometrial implantation defect healed.
Bleeding occasionally occurs at implantation site at Day 28 (from ovulation) of normal cycle?
*The bleeding may fool the lady and make her think that she is having her period.


Cellular columns from Cytotrophoblast invading Syncytiotrophoblast forming Primary Villi which is the beginning of placenta.
Cytoplast will form finger like pillar & penetrate inside forming Primary Villi.

*Now we have completely implantation (implantation ends at day 13).


Note: Fertilization occurs at Day 13 of ovulation so when we want to do the math we add 13.

e.g.: Day 8 from fertilization = (8+13=21) Day 21 from ovulationàsecretory phase of uterine cycle.


-so by day28(13 from fertilization) the embryo differentiates into 2 layers(endoderm-ectoderm) and placenta will have started then.


"Two little mice fell in a bucket of cream. The first mouse quickly gave up and drowned. The second mouse, wouldn't quit. He struggled so hard that eventually he churned that cream into butter and crawled out. As of this moment, I am that second mouse."


I want to dedicate this sheet to:

Children of Palestine, Iraq & Lebanon (You are the real men).


And to all my friends who:

-Study on medicine faculty:

5aled 7ajeer(Mr.”bla 10 3la al shagarah”),Ebraheem Abo Dya, M2moon sha3ban, Ahmad Abo Hallawah, Osamah 5aleel, Ahmad Abo Khadeegah ,5aled Daye3, Yazeed Al-naif , Yazeed Qaisyah , M2yad Ketaneh,7amzeh jassar , Qosay 3zzam ,Moh. Tamimy, Moh. Momany , Yazan 3toom(y36eek el 3afyeh) ,3dnan Al-3aref (ya 7ram Chelsea) , mo2men K7aleh , Abd Allah Tayyem ,Ebraheem Al-Sa3eedy , Moh. Al-quasmeh ,Moh. Abo 3rjah, Ahmad 7ra7shah , Ahmad 7na6y , 9ohayb Al-3bady , samy 3bdeen , Ahmad Al-shalabi, Moh sbo3, Zaid mal7ees .

-Study on other faculties:

Sa2ed kharoob, Moh. Bdar, J3fary (The tall) ,Ahmad (Sokkar) , Mahmood & ahmad Abo Znai6, Monther, Ahmad hamshary , 6ohayb, shukri, 30mar semreen,Wael 3lawneh,Muhannad,Nusaiba .

-Study on other Universities:

3la2 mara3’y, Wael Abo Hassan, Fat7y, Moh. Faroq, 7osam.

-Study on other countries:

Abo hmade (King kong) , Marwan 5amees.((In Egypt)).

J3fary”the short” (sht2nalak wala) ((In U.S.A.)).

-And to Dr. Maher Al-Hadidi.

-And to my little brother Hashem Al-Faqih.


*And to people who are special to my heart*

Mohammad Al-Faqih

sheet no . 36

Small Intestine:

- It is a complete intraperitoneal tube, about 6M in length.
- Extending from duodenojejunal junction to the ileocecal junction.
- It extends from the left side(beginning) to the right side(end) of vertebral column.
- They are anchored to the posterior abdominal wall via fan-shaped double layer of peritoneum called mesentery of small intestine.

- Divided into 2 parts:

1. Jejunum.
2. Ileum.
These parts are known by their specific features,,
--> Jejunum:
* Representing 2/5 of small intestine = 2.5m.
* Larger in diameter.
* Thick in wall.
* Red in color (because of high vascularity; high absorption).
--> Ileum:
* Representing distal 3/5 of small intestine = 3.5m.
* Smaller in diameter.
* Thin in wall.

* Pale in color (less vascularity; no need for efficient absorption; semi-solid food).
- Arterial supply of small intestine: by Superior Mesenteric Artery.
- Venous drainage of small intestine: to the portal vein.

- Location: located around umbilicus, that's why colicky pain from small intestine is usually felt around umbilicus.


Large Intestine:

- Forms a frame around small intestine.
- Consist of:
(1) Appendix.
(2) Cecum (one-way tube).
(3) Ascending colon.
(4) Hepatic angle.
(5) Transverse colon.
(6) Splenic angle.
(7) Descending colon.
(8) Sigmoid colon.
(9) Anal canal and rectum.
- All of it is intraperitoneal except: ascending colon and descending colon, acting as pillars.
* Appendix:
- Intraperitoneal blind tube (highly mobile), with mesentery.
- Longer in children, shorter in old ages, that's why appendicitis is more common in children and young adults.
- Has base, which is fixed, and apex, which is mobile.
- Positions of the tip of appendix (apex):
1) Retrocecal (behind Cecum, as Retro ≡ behind) at 12 o'clock à (64%).
2) Pelvic (in the pelvis) at 6 o'clock à (32%).
3) In the left side at 3 o'clock à (1%).
4) In the right side at 9 o'clock à (2%).

♣NOTE:
- Below appendix we have the femoral nerve, so a patient with appendicitis:
• who is flexing his hip as he couldn't extend it because that will irritates the femoral nerve causing pain --> Retrocecal Appendicitis.

• who has problems in urination, problems in uterus or ovary in female, and constipation or diarrhea --> Pelvic Appendicitis.

- Appendicitis is less common in old ages also because the appendix is transferred into fibrous tissue in old adults [Atrophy], and it's shorter.
- By a line extending from anterior superior iliac spine to umbilicus, we can allocate the base of appendix : at the point between the medial 2/3 and the lateral 1/3.

* Cecum:
- Intraperitoneal blind tube.
- Located in the right iliac fossa (over iliacus).
- Recieves ileum, and gives appendix and ascending colon.

♣ It is the site involved in constipation, so any problem of constipation will affect iliacus and femoral nerve, and vice versa.

* Ascending colon:

- Retroperitoneal.
- Close to right kidney and right ureter (in the right lumbar region).

* Hepatic angle (Right angle):

- Between ascending and transverse colon.
- It is related to visceral surface of liver (in the right hepatic region).

* Transverse colon:

- Intraperitoneal.
- Extending from hepatic angle to Splenic angle ( from liver to spleen).
-->Proximal 2/3 is supplied by Superior Mesenteric Artery.
--> Distal 1/3 is supplied by Inferior Mesenteric Artery.

*splenic angle:

- higher in position than the hepatic angle, that's why gases are collected in the splenic angle, causing pain in the left side of abdomen that is exaggerated when the patient is standing and fades when he lies on his back.

* Descending colon:

- Retroperitoneal.
- Related to left kidney and left ureter (in the left lumbar region).

* Sigmoid colon:
- S-shaped tube.
- Intraperitoneal.
- located in the left iliac fossa.

** Cecum is located in the right iliac fossa, opposite to it is the sigmoid colon in the left iliac fossa.
* Specific features of Large intestine
--> Haustra (Sacculation); bulges.

They are the site of fermentation of fibers by a bacteria located there.
• Crohn's Disease is caused by the laze of mucosa of the GI tube.



"Education is replacing closed minds with opened ones..."

Sawsan Tabaza . .
I'd like to dedicate this sheet to all my friends, especially:
Sondos Alkhatib (Sannnoon), Ruba Almohtaseb (Apple vs. Carrot :D), Lama Jamal (kf o ana a3rf :p,, o a5eran.. Mabroook Elro5sa :D !!!), Aya Bni-Kenanah:D, Samar Alrahmeh (J), Nisreen Abu-osbeh, Haneen Shraideh, Dania Dahmsh, Ruba Halaseh, Shatha Atteli, Waed Swaelmeen, Suzan Mbaydeen, Jamela, Najd Quraan, Rawan Saleh, Zein, Ala' abd alra'ouf, Bayan Alkhdoor, Rasha Jabra, Aseel.

And to all my colleagues.
Special thanks for: Yezan 3toom, Ahmed Abu-khadigh, and Hamza Jassar.

sheet no . 35

*The Stomach*
it is the upper dilated part of the GI tube.
Located in the epigastric, umbilical & left hypochondriac regions.
Its normal shape is (J) shape.
It's size small when empty, larger when filled--->it's size & shape depends on habits of eating.
It is a completely intraperitoneal organ with the following parts:
two ends:

→ cardiac end which receives Esophagus.
→ pyloric end which controls evacuation of stomach & continue as duodenum.

*between these two ends stomach is relatively fixed (like a plastic bag filled with water between 2 hands), the rest of it is mobile(expandable).

two surfaces:
→ anterior parietal surface (related to anterior abdominal wall).
→ posterior visceral surface (related to viscera).
SO after eating if you want to lie you should lie on the RIGHT side because when lying on your face you will push the anterior abdominal wall & when lying on back you will push the viscera.
3.two curves:
-Greater curvature: attached with large double layer of peritoneum called GREATER OMENTUM.
-Lesser curvature: it is indented at its bottom forming (Angular notch), attached with double layer of peritoneum called LESSER OMENTUM.
Stomach is attached to its neighbors through Greater & Lesser omentums.



*Parts of Stomach:

Fundus:

Highest (upper) part of stomach, always filled with gas.
Note: If you eat large amount of food the gas will push the diaphragm then to the left lung so you cannot breathe properly.

Body (main part):
Largest part of stomach, it is the blender & mixer of food with gastric juices like HCl.

Pylorus:

Start at Angular notch THAT'S WHY angular notch is a good clinical landmark to separate Pylorus from Body of stomach.
it has 3 parts:
1.Pyloric Antrum
2.Pyloric Canal → through which food transferred from stomach to duodenum.
3.Pyloric Sphincter → control evacuation of stomach.
Note: when the milk return back in new born baby that's because the Sphincter is closed (the stomach will appear soup-dish like → stomach dilation will cause feed back).

*The wall of stomach formed of the following layers: (from in to out)

I. Mucosa: thrown into longitudinal folds called RUGAE to increase the surface area for efficient absorption & digestion.

*Opposite lesser curvature there are 2 permanent longitudinal folds having a canal between them called (Gastric Canal) which is the common site of Gastric Ulcer. BECAUSE the 1st sip of food is passing through gastric canal so we should begin eating with water or anything that soothes mucosa (milk, salad…) & the other food then will go without causing Gasteritis.

II. Submucosa
III. Muscolosa: (Muscular layer)
Formed of 3 layers:
→ outer longitudinal
→ middle circular to form Sphincter
→ inner oblique
IV. Serousa
-Arterial Supply: stomach supplied through branches from Celiac artery.
-Venous Drainage: stomach drainage from GI tube is carried through Portal Vein loaded with products of digestion & foreign substances to be carried to the liver then to inferior vena cava for filtration from harmful substances absorbed.

*Duodenum*

-(G) shaped tube, about 10 inches in length
-extending from stomach at Pyloroduodenal junction & end at small intestine in Duodenojejunal junction.
-surrounding(embracing/framing) the head of Pancreas.
-Divided into 4 parts:
The 1st part
- Crossing L1
- horizontal part
- 2 inches in length → the 1st inch is intraperitoneal
→ the 2nd inch is retroperitoneal
The 2nd part
- Parallel to right side of L1,L2,L3
- descending part
- 3 inches in length, retroperitoneal
- it is important part because receives CBD (Common Bile Duct) & Pancreatic Duct.
- site of digestion of Protein & Fat.
*Site of interance of CBD divides the duodenum into:
1. Proximal part developed by Foregut → supplied by Celiac A.
2. Distal part developed by Midgut → supplied by SMA (superior mesenteric artery).
The 3rd part
- Crossing L3
- horizontal part
- 3 inches in length, retroperitoneal
- crossed by superior mesenteric vessels.
The 4th part
- extending from L3,L2 above (parallel to them)
- ascending part
- 2 inches in length
→ proximal inch is retroperitoneal
→ distal(last) inch is intraperitoneal (due to connection with small intestine to be in mobility)
THUS, all duodenum is retroperitoneal except the 1st & the last inches.
**the lengths of the 4 parts from 1st to 4th are (2-3-3-2)
Arterial Supply:
- Celiac Artery for proximal part.
- Superior Mesentric Artery (SMA) for distal part.



*****************
Finally, I want to dedicate this sheet to all medical students especially:
Nesreen Abu Osba(zoro is the best), Amal Al7elo(You're the best) ,Sawsan Tabaza(snsn thanks), Sondos Al5teeb(tararara!!), Heba Nemer(miss purple), Heba Abu 5eran, Lama Jamal(twirl!), Ruba Almo7tseb(wd3k bel7yah), Aya Bni Kenanah, Rawan Alrajbi, Rawan Sale7, Rawan Ghazal, Ala2 3bd Elr2of, Do3a2 Abu Jame3,Byan 5door, Zein Njada, W3d Swylmeen,Suzan Mbydeen, Jamela, Rasha Jabra, Nadia, Dima, Ala2 7jazi, As7ar,Rand Abu Lubdeh ,Lubna, Samar Taqatqa, Muna, Do3a2 jra7,Do3a2 Al3antri, Najd AlQur3an, Aseel ,Ruba Halaseh, Nuha.
"الزهور كائن هش جداً .. وحتى لا تتكسر أثناء الأمطار يجب أن تكون مغطاة .. كما أنها أيضاً تحتاج إلى ضوء الشمس حتى لا تذبل .. وإذا هبت العاصفة فلا فائدة من الغطاء..."
Best Wishes, *SSRH*
Samar Al-Rahmeh
ملاحظة: لقد تم تغيير موعد الامتحان النهائي لمادة الثقافة الاسلامية لطلاب الطب بحيث أصبح 4/6/2008 بدلا من 7/6/2008 الساعة 11:30 في مبنى ال
IT