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1、Gastrointestinal tract 胃肠道胃肠道Accessory organs辅助器官辅助器官(Para. 1)The organization ofThe organization ofthe gastrointestinalthe gastrointestinaltracttractWhat are the four layers?What are the four layers?(Concentric layers)(Concentric layers)SublayersSublayersIntrinsic nerves (Intrinsic nerves (内神经内神经内神
2、经内神经) )The gastrointestinal tract胃肠道胃肠道The submucosal plexus(Meissner plexus) 黏膜下层神经丛黏膜下层神经丛（即迈斯纳神经丛）即迈斯纳神经丛） The myenteric plexus(Auerbach plexus) 肠肌神经丛肠肌神经丛（即奥尔巴赫神经丛（即奥尔巴赫神经丛) The subserosal plexus浆膜下神经网丛浆膜下神经网丛 What are the three nerve plexuses?唾液唾液 salivasaliva味蕾味蕾 taste budstaste buds嗅神经嗅神经 olf
3、actory nervesolfactory nerves胃液的分泌胃液的分泌 the secretion of gastric juicethe secretion of gastric juice恒牙恒牙 permanent teethpermanent teeth咀嚼咀嚼 masticationmastication食管食管 esophagusesophagus蠕动蠕动 peristalsisperistalsis外层纵向肌外层纵向肌 outer longitudinal layers of musclesouter longitudinal layers of muscles内层环形肌
4、内层环形肌 inner circular layers of musclesinner circular layers of musclesMouth and Esophagus口腔和食道口腔和食道1.Three pairs of salivary glands1.Three pairs of salivary glands1 liter of saliva per day1 liter of saliva per daysalivation唾液分泌唾液分泌1.Three pairs of salivary glands1.Three pairs of salivary glands1 lit
5、er of saliva per day1 liter of saliva per day2. Autonomic nervous system 2. Autonomic nervous system ( (自主神经系统自主神经系统自主神经系统自主神经系统) )controls salivation.controls salivation. (sympathetic and (sympathetic and parasympathetic)parasympathetic) (But not regulated by hormones)(But not regulated by hormones
6、)salivation唾液分泌唾液分泌食糜食糜 chymechyme十二指肠十二指肠 duodenum duodenum The stomachs major anatomic The stomachs major anatomic boundaries:boundaries:食管括约肌食管括约肌 贲门贲门 胃大弯和胃小胃大弯和胃小弯弯 幽门括约肌幽门括约肌 十二指肠十二指肠 What are the functional areas of the What are the functional areas of the stomach?stomach?fundus, body, antrum
7、fundus, body, antrumStomach胃胃胃壁胃壁 stomach wallstomach wall 斜肌层斜肌层 a layer of oblique musclea layer of oblique muscle中环层中环层和外纵层外纵层在胃底胃底最薄The circular The circular andand longitudinal layers of longitudinal layers of muscle muscle are thinnest in theare thinnest in the fundus fundus.胃体和胃窦胃窦逐渐变厚The lay
8、ers become progressively The layers become progressively thicker in the body andthicker in the body and antrumantrum. .胃粘膜胃粘膜 the mucosa of the stomachthe mucosa of the stomachStomach胃胃1. 血液通过腹腔一支动脉腹腔一支动脉输入胃中Blood is supplied to the stomach byBlood is supplied to the stomach by a a branch of the cel
9、iac artery.branch of the celiac artery.2. 主动脉沿胃大弯胃大弯和胃小弯胃小弯分布 Major arteries lie alongMajor arteries lie along the greater and the greater and lesser curvatures.lesser curvatures.3. 分叉深入浆膜浆膜和肌层肌层 branch and penetratebranch and penetrate the serosathe serosa and and muscle layersmuscle layers4. 形成丰富的
10、侧支循环侧支循环form a richform a rich collateral circulation collateral circulationStomach胃胃Cardiovascular System: Major Vessels 1. renal artery 肾动脉肾动脉 2.vertebral artery 脊椎动脉脊椎动脉 3. subclavian artery 锁骨下动脉锁骨下动脉 4. aorta 主动脉主动脉 5. coronary artery 冠状动脉冠状动脉 6. celiac artery 腹腔动脉腹腔动脉 7. superior mesenteric ar
11、tery 肠系膜上动脉肠系膜上动脉 8. lumbar artery 腰动脉腰动脉 9. inferior mesenteric artery 肠系膜下动脉肠系膜下动脉 10. gonadal artery 生殖腺动脉生殖腺动脉 1.renal artery 肾动脉肾动脉2.vertebral artery 脊椎动脉脊椎动脉3. subclavian artery 锁骨下动脉锁骨下动脉4. aorta 主动脉主动脉 5. coronary artery 冠状动脉冠状动脉6. celiac artery 腹腔动脉腹腔动脉7. superior mesenteric artery 肠系膜上动肠系膜
12、上动8. lumbar artery 腰动脉腰动脉9. inferior mesenteric artery 肠系膜下动肠系膜下动10. gonadal artery 生殖腺动脉生殖腺动脉 A rich circulationstomachliverGastric VeinSplenic Vein静止状态下没有壁张力壁张力In resting state, no In resting state, no wall tensionwall tension. .吞咽动作致使底部底部松弛Swallowing causes Swallowing causes the fundusthe fundus
13、to relax. to relax.食物存储在垂直层或斜纤层垂直层或斜纤层Food is stored in Food is stored in vertical or oblique layersvertical or oblique layers液体相对快速地流入胃窦胃窦Fluids flow relatively quickly down to Fluids flow relatively quickly down to the antrumthe antrum. .蠕动波蠕动波使胃动力开始增强Gastric motility increases with Gastric motili
14、ty increases with peristaltic wavesperistaltic waves(蠕动收缩频率)同时受神经和激素活动神经和激素活动影响。Influenced by Influenced by neural and hormonal activityneural and hormonal activity. . Gastric Motility胃运动胃运动1. 胃液胃液或胃分泌物胃分泌物gastric juices gastric juices oror gastric secretion gastric secretion2. 粘液粘液、酸酸、酶酶、激素激素和内因子内因
15、子Mucus, acid, enzymes, hormones, Mucus, acid, enzymes, hormones, and intrinsic factorintrinsic factor3.激素激素被分泌到血液里The hormones The hormones are secreted into the blood.are secreted into the blood.4. 其他胃分泌物直接进入胃腔胃腔。The other gastric secretions into The other gastric secretions into the stomach the st
16、omach lumenlumenGastric Secretion胃分泌胃分泌粘液粘液形成一道防护屏障来抵御形成一道防护屏障来抵御酸酸和和蛋白水解酶蛋白水解酶。Mucus Mucus forms a protective barrier forms a protective barrier againstagainst acid acid and and proteolytic proteolytic enzymesenzymes. .Gastric Secretion胃分泌胃分泌1. 1. 胃液的成分取决于其胃液的成分取决于其胃液的成分取决于其胃液的成分取决于其体积体积体积体积和和和和流动速
17、度流动速度流动速度流动速度The composition of gastric juice depends onThe composition of gastric juice depends on volume and and flow rate2. 氢和氯氢和氯, 钠钠, 钾钾 的浓度变化的浓度变化 The change of the concentrations ofThe change of the concentrations of hydrogen and chloride, sodium , and potassium3. 3. 分泌的速度和体积在早上为最小值，在分泌的速度和体积
18、在早上为最小值，在分泌的速度和体积在早上为最小值，在分泌的速度和体积在早上为最小值，在下午和晚上达到最大值。下午和晚上达到最大值。下午和晚上达到最大值。下午和晚上达到最大值。The rate and volume of secretion are lowest The rate and volume of secretion are lowest in the morning and evening.in the morning and evening.Gastric Secretion胃分泌胃分泌What inhibits gastric secretion(What inhibits ga
19、stric secretion(胃分泌胃分泌)?)? (L.95-96) (L.95-96) Unpleasant odors and Unpleasant odors and tastes; Rage, fear, paintastes; Rage, fear, painWhat causes increased secretions?What causes increased secretions?分泌物增多与敌对心理或敌意厌恶分泌物增多与敌对心理或敌意厌恶感有关感有关. .Gastric Secretion胃分泌胃分泌1. 1. 功能上可分为三部分：十二指肠，功能上可分为三部分：十二指肠
20、，功能上可分为三部分：十二指肠，功能上可分为三部分：十二指肠，空肠和回肠空肠和回肠空肠和回肠空肠和回肠 Divided into 3 segments:Divided into 3 segments: the the duodenum, jejunum, and ileumduodenum, jejunum, and ileum2. 腹膜腹膜是包裹在腹部器官和是包裹在腹部器官和骨盆腔骨盆腔上的一层上的一层浆膜浆膜浆膜浆膜 The peritoneumThe peritoneum is theis the serous serous membranemembrane surrounding th
21、e organs of surrounding the organs of abdomen andabdomen and pelvic cavity. pelvic cavity.Small Intestine小肠小肠Small intestineIleocecal valvejejunumA suspensory ligamentduodenum jejunumA suspensory ligament腹膜腹膜PeritoneumPeritoneumMesentery1. 十二指肠的动脉供应主要由十二指肠的动脉供应主要由胃十胃十二指肠动脉二指肠动脉提供提供。 The arterial sup
22、ply to the duodenum The arterial supply to the duodenum arises primarily fromarises primarily from the gastroduodenal artery.2. 小肠平滑肌小肠平滑肌分布为两层：外部的分布为两层：外部的纵层和内部较厚的环层。纵层和内部较厚的环层。The smooth muscles of the small intestine are arranged in two layers.are arranged in two layers. Small Intestine小肠小肠Arteri
23、al supply to small intestineGastroduodenal artery食物食物 氯化氢和胃蛋白酶氯化氢和胃蛋白酶的作用的作用(分解食物纤维和蛋白分解食物纤维和蛋白 ) 食糜食糜 胰腺酶，肠胰腺酶，肠道酶和胆盐的作用道酶和胆盐的作用 碳水碳水化合物化合物/蛋白质蛋白质/脂肪分解脂肪分解 水水/维生素维生素/电解液通过传输，电解液通过传输，扩散或易化扩散扩散或易化扩散 经肠经肠道黏膜道黏膜 吸收。吸收。 Intestinal Digestion Intestinal Digestion and Asborptionand Asborption肠道消化与吸收肠道消化与吸收
24、小肠运动小肠运动小肠运动小肠运动食糜食糜食糜食糜刺激肠道运动刺激肠道运动刺激肠道运动刺激肠道运动 混合有来自混合有来自混合有来自混合有来自肝脏肝脏肝脏肝脏，胰腺胰腺胰腺胰腺和和和和肠腺肠腺肠腺肠腺的分泌物的分泌物的分泌物的分泌物 搅拌运动搅拌运动搅拌运动搅拌运动 腔腔腔腔内物内物内物内物接触到接触到接触到接触到绒毛吸收细胞绒毛吸收细胞绒毛吸收细胞绒毛吸收细胞 推进推进推进推进使食糜进入大肠使食糜进入大肠使食糜进入大肠使食糜进入大肠 ChymeChyme stimulates intestinal movements Mix in secretion from the liver, pancre
25、as, liver, pancreas, and and intestinal glands intestinal glands a churning motion a churning motion brings brings the luminal contentthe luminal content into contact with into contact with the absorbing cells of the villi. the absorbing cells of the villi. Advance Advance the chyme toward the large
26、 intestine.the chyme toward the large intestine.Intestinal Motility肠道运动肠道运动肠道运动受两种运动影响：结肠袋分节运动和蠕动。Intestinal motility is affected by Intestinal motility is affected by two movements:two movements:Haustral segmentationHaustral segmentationperistalsis peristalsis Intestinal Motility肠道运动肠道运动The The lar
27、ge intestinelarge intestine consists of: consists of:cecum cecum 盲肠盲肠盲肠盲肠 a pouch a pouchappendix appendix 阑尾阑尾阑尾阑尾 vermiform vermiform colon colon 结肠结肠结肠结肠rectum rectum 直肠直肠直肠直肠anal canal anal canal 肛管肛管肛管肛管Large Intestine大肠大肠The four parts of the colonThe four parts of the colonascending colonasce
28、nding colon 升结肠升结肠升结肠升结肠transverse colon transverse colon 横结肠横结肠横结肠横结肠descending colon descending colon 降结肠降结肠降结肠降结肠sigmoid colonsigmoid colon 乙状结肠乙状结肠乙状结肠乙状结肠Large Intestine大肠大肠1.肠内物通过盲肠和结肠受肠内物通过盲肠和结肠受肠内物通过盲肠和结肠受肠内物通过盲肠和结肠受两个括约两个括约两个括约两个括约肌肌肌肌控制：控制：控制：控制： the ileocecal valve the ileocecal valve回盲瓣回
29、盲瓣回盲瓣回盲瓣 控制食糜从回肠进入盲肠控制食糜从回肠进入盲肠控制食糜从回肠进入盲肠控制食糜从回肠进入盲肠 the OBeirne sphincter the OBeirne sphincter奥贝恩括约肌奥贝恩括约肌奥贝恩括约肌奥贝恩括约肌控制废物从乙状结肠进入直肠。控制废物从乙状结肠进入直肠。控制废物从乙状结肠进入直肠。控制废物从乙状结肠进入直肠。2. 2. anal sphincters anal sphincters 肛门括约肌肛门括约肌肛门括约肌肛门括约肌 internal anal sphincter internal anal sphincter肛门括约肌肛门括约肌肛门括约肌肛门
30、括约肌 external anal sphincter external anal sphincter肛门括约肌肛门括约肌肛门括约肌肛门括约肌 Large Intestine大肠大肠 What causes to kill pathogens (What causes to kill pathogens (病原病原病原病原体体体体) and bacteria throughout the ) and bacteria throughout the gastrointestinal tract? gastrointestinal tract? Acid in the stomachAcid in
31、 the stomachBile acid secretionBile acid secretionIntestinal motilityIntestinal motilityAntibody productionAntibody production Where are anaerobes mainly found?Where are anaerobes mainly found? (L.196-197) (L.196-197)Intestinal Bacteria肠道细菌肠道细菌Accessory Organ of Digestion消化的辅助消化的辅助器官器官What are the a
32、ccessory organs of What are the accessory organs of digestion?digestion?Liver Liver produces bilebilegallbladdergallbladder stores bilebileexocrine pancreasexocrine pancreas produces enzymesenzymes needed for the complete digestion of carbohydrates, proteins, and fats. Besides, produces an alkaline
33、fluidalkaline fluid.LiverLiver It also receives nutrients absorbed by the small intestine, metabolizing and synthesizingAccessory Organ of Digestion消化的辅助消化的辅助器官器官Liver-Secretion of Bile1.Where is the liver located?Where is the liver located?2. L.2163.2. 2. The metabolic function of the liverThe meta
34、bolic function of the liver require a large amount of bloodrequire a large amount of blood hepatic arteryhepatic artery( ( 肝动脉肝动脉肝动脉肝动脉) )provides provides oxygenated blood oxygenated blood portal venous blood portal venous blood ( (门静脉血门静脉血门静脉血门静脉血) ) constitutes70% of the blood supply constitutes7
35、0% of the blood supply to the liver. to the liver.Accessory Organ of Digestion消化的辅助消化的辅助器官器官Liver-Secretion of BileSecreting 700 to 1200ml bile per daySecreting 700 to 1200ml bile per dayWhat does the bile contain?What does the bile contain? bile salts bile salts cholestrol cholestrol bilirubin, bil
36、irubin, electrolytes electrolytes water water胆盐、胆固醇、胆红素、电解液和水胆盐、胆固醇、胆红素、电解液和水 What is the function of bile salts?What is the function of bile salts? (L. 233-235)(L. 233-235)Accessory Organ of Digestion消化的辅助消化的辅助器官器官Gallbladder (Gallbladder (胆囊胆囊胆囊胆囊) )1.Position and FunctionPosition and Function2.Ho
37、w does How does the bilethe bile move? move?3. 4. 胆汁从肝脏流出，经由左或右肝胆汁从肝脏流出，经由左或右肝胆汁从肝脏流出，经由左或右肝胆汁从肝脏流出，经由左或右肝导管进入肝总管，并在此遇到奥迪导管进入肝总管，并在此遇到奥迪导管进入肝总管，并在此遇到奥迪导管进入肝总管，并在此遇到奥迪括约肌的阻力。奥迪括约肌掌控胆括约肌的阻力。奥迪括约肌掌控胆括约肌的阻力。奥迪括约肌掌控胆括约肌的阻力。奥迪括约肌掌控胆汁流入十二指肠。此后，胆汁经由汁流入十二指肠。此后，胆汁经由汁流入十二指肠。此后，胆汁经由汁流入十二指肠。此后，胆汁经由胆管进入胆囊，并在此贮存、变
38、浓。胆管进入胆囊，并在此贮存、变浓。胆管进入胆囊，并在此贮存、变浓。胆管进入胆囊，并在此贮存、变浓。Accessory Organ of Digestion消化的辅助消化的辅助器官器官Gallbladder (Gallbladder (胆囊胆囊胆囊胆囊) ) 3. How does 3. How does GallbladderGallbladder work?work? 饭后饭后饭后饭后3030分钟内，胆囊开始收缩，奥分钟内，胆囊开始收缩，奥分钟内，胆囊开始收缩，奥分钟内，胆囊开始收缩，奥迪括约肌松弛，迫使胆汁通过大的迪括约肌松弛，迫使胆汁通过大的迪括约肌松弛，迫使胆汁通过大的迪括约肌松弛，
39、迫使胆汁通过大的十二指肠乳突进入十二指肠。在口十二指肠乳突进入十二指肠。在口十二指肠乳突进入十二指肠。在口十二指肠乳突进入十二指肠。在口腔和胃消化阶段，迷走神经的类胆腔和胃消化阶段，迷走神经的类胆腔和胃消化阶段，迷走神经的类胆腔和胃消化阶段，迷走神经的类胆碱分支控制胆囊的收缩。胆囊收缩碱分支控制胆囊的收缩。胆囊收缩碱分支控制胆囊的收缩。胆囊收缩碱分支控制胆囊的收缩。胆囊收缩的荷尔蒙调节源于缩胆囊素和胃动的荷尔蒙调节源于缩胆囊素和胃动的荷尔蒙调节源于缩胆囊素和胃动的荷尔蒙调节源于缩胆囊素和胃动素的释放，缩胆囊素和胃动素是在素的释放，缩胆囊素和胃动素是在素的释放，缩胆囊素和胃动素是在素的释放，缩胆
40、囊素和胃动素是在脂肪环境下十二指肠黏膜分泌的。脂肪环境下十二指肠黏膜分泌的。脂肪环境下十二指肠黏膜分泌的。脂肪环境下十二指肠黏膜分泌的。Accessory Organ of Digestion消化的辅助消化的辅助器官器官Exocrine Pancreas (Exocrine Pancreas (外分泌胰腺外分泌胰腺外分泌胰腺外分泌胰腺) )1.Location of PancreasLocation of Pancreas2.Why is the pancreas unique?Why is the pancreas unique?3. It has both endocrine and It
41、 has both endocrine and exocrine functions.exocrine functions.4.3. What does the endocrine 3. What does the endocrine pancreas(pancreas(内分泌胰腺内分泌胰腺内分泌胰腺内分泌胰腺) do?) do?5. secretes hormones:secretes hormones:6. insulininsulin ( (胰岛素胰岛素胰岛素胰岛素) )7. glucagonsglucagons ( (高血糖素高血糖素高血糖素高血糖素) )Accessory Organ
42、 of Digestion消化的辅助消化的辅助器官器官4. What does the exocrine pancreas (4. What does the exocrine pancreas (外外外外分泌胰腺分泌胰腺分泌胰腺分泌胰腺) do?) do? secrete secrete enzymesenzymes( (酶酶酶酶) and ) and alkaline alkaline fluids fluids ( (碱性流体碱性流体碱性流体碱性流体) ) Accessory Organ of Digestion消化的辅助消化的辅助器官器官 Secretions Secretions d
43、rain into a system of ducts drain into a system of ducts that leads to that leads to the pancreatic ductthe pancreatic duct, which , which empties into empties into the common bile ductthe common bile duct at at the ampulla of Vatethe ampulla of Vate. . 分泌物分泌物分泌物分泌物流入导管系统，导管系统通流入导管系统，导管系统通流入导管系统，导管系
44、统通流入导管系统，导管系统通向向向向胰导管胰导管胰导管胰导管，然后进入，然后进入，然后进入，然后进入法特壶腹法特壶腹法特壶腹法特壶腹处的处的处的处的总胆管总胆管总胆管总胆管。 Accessory Organ of Digestion消化的辅助消化的辅助器官器官 In some individuals In some individuals an accessory ductan accessory duct branches off branches off the pancreatic ductthe pancreatic duct and and drains directly into drains directly into the duodenumthe duodenum at at an opening called an opening called the minor duodenal the minor duodenal papillapapilla. . 在某些个体中可见在某些个体中可见辅助性导管辅助性导管分支于分支于胰导胰导管管，胆汁在被称为，胆汁在被称为小的十二指肠乳突小的十二指肠乳突的开的开口处直接进入口处直接进入十二指肠十二指肠十二指肠十二指肠。
