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Kálmán M: Morphology and histology of the large intestine and rectum

Kálmán M: Morphology and histology of the large intestine and rectum. To the lectures for EM 1-8 and 9-17 on March 21 and 22, 2019. Mainly the parts not emphasized in the textbook. The main points :

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Kálmán M: Morphology and histology of the large intestine and rectum

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  1. Kálmán M:Morphology and histology of thelargeintestine and rectum Tothelecturesfor EM 1-8 and 9-17 onMarch 21 and 22, 2019. Mainlythepartsnotemphasizedinthetextbook.

  2. The main points: The rectum is not ’rectus’ i.e. straight, butS-shaped, theopeningdirectedposteriorlyratherthandownward! The lowercurvaturecontactstheprostateorthevaginalfornix. The analcanal has 3 parts intestinal (columnar: columnae and sinuses) – intestinalepithalium belowit: thepectinate line – epi-ectodermalborder hemorrhoidal (venousplexus) stratifiedsquamousepithelium. belowit: white line, and a shellowgroove (note: attheborder of the 2 subdivisions of ext. sphinter, seelater) cutaneouskeratinizedstratifiedsquamousepithelium The analcanal is belowthefloor of thepelvis (notyetlectured) The externalvoluntarysphincteronsists of 3 parts: deep, supeficial and subcutaneous. Thalastone is most important. The longitud. smooth has tendon-likeelongations, whichformconnectivetissueslings (conjointfibromuscularlayer) aroundthefascicles of thesubcutaneousext. sphincter) The territories of arteriescorrespondtothedevelopmentalorigins: superiorrectal (most part) – hindgutderivative middlerectal (small, approx. thesinuses) - cloacalderivative inferiorrectal - proctodeumderivative, ectodermal, belowthepectinateline.

  3. The Riolanarcades The term ‚small’ or ‚first’ Riolanarch (theanastomosisbetweenthesup. and inf. Pancreaticoduodenalarteries is inuseactuallyonlyinourinstitute; itisnotappliedinthetextbooks. The mame ‚arch of Riolan’ is most probablyincorrectlyappliedonthemarginalartery; it is theanastomosis – orarch – of Drummond. WhicharterywasdescribedbyRiolanit is alreadynotclear; most probablyitwastheso-calledmeanderingmesentericartery, whichalsointerconnectsthemiddle and leftcolicarteriesbutin a more proximaland sinuous line. Forliterature, seethenextpage. Note: these and similarnames of authors (eponymes) arenotto be learnedbystudents; weusethemonlyas a homagetotheelders.

  4. Papershelpingclarifythr ‚Riolan’ question. Onlyforenthusianisticvolunteers! Note: thefirstonewaswrittenby dr. Ágnes Nemeskéri and herco-workersfromourinstitute. Szuák, András; Halász, Vanda; Gáti, Endre; Harsányi, László; Nemeskéri, Ágnes (2016) FirstReportonArterialAnastomosisBetweenTransversePancreatic and LeftColicArteries. CaseStudies Journal Vol 5, Issue 2, Page 1 Lange, J.F., Komen, N., Akkerman, G., Nout, E., Horstmanshoff, H., Schlesinger, F., Bonjer, J., Kleinrensink, G.J., 2007. Riolan’sarch: confusing, misnomer, and obsolete. A literaturesurvey of theconnection(s) betweenthesuperior and inferiormesentericarteries. The American Journal of Surgery. 193, 742-748. Walter, T.G., 2009. MesentericVasculature and CollateralPathways. Semin. Intervent. Radiol. 26(3), 167-174. FisherDf, Fry WJ. CollateralMesentericCirculation " Surgery, Gyencology and Obstetrics. 1987, 164(5):487-492 Gourley EJ,  Gering SA. "The MeanderingMesentericArtery: A HistoricReview and SurgicalImplications." Disease of the Colon & Rectum. Vol 48:5 (2005) pp 996-1000 (thefigure is takenfromthispaper). Douard R, Chevallier JM, Delmas V, Cugnenc PHClinical interest of digestivearterialtrunkanastomoses. SurgRadiolAnat. 2006 Jun;28(3):219-27.

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