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Large intestine

Large intestine. Anatomy of the Large Intestine. 2. Large Intestine • Extends from ileocecal valve to anus • Length = 1.5- 2.5m = 5 feet • Regions – Cecum = 2.5- 3 inch – Appendix= 3-5 inch – Colon. Ascending= 5 inch Transverse= 15 inch Descending= 10 inch Sigmoid colon = 10 – 15 inch.

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Large intestine

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  1. Largeintestine

  2. AnatomyoftheLargeIntestine 2

  3. LargeIntestine •Extendsfromileocecalvalvetoanus •Length=1.5-2.5m=5feet •Regions –Cecum=2.5-3inch –Appendix=3-5inch –Colon Ascending=5inch Transverse=15inch Descending=10inch Sigmoidcolon=10–15inch • • • • –Rectum=5inch –Analcanal=4cm 3

  4. Generalfeaturesoflargeintestine 1-Sacculation=Haustra 2-Teaniacoli(threeseparate longitudinalribbonsofsmooth muscle) exceptappendexand rectum 3-Appendicesepiplolca(adipose structuresprotrudingfromthe serosalsurfaceofthecolon) exceptappendix,Cecumand rectum

  5. LARGEINTESTINEANATOMY

  6. Cecum Itisablind-endedpouch Site:situatedintherightiliacfossa,abovethelat½ofinguinalligament Size:Itisabout3inchindiameter Completelycoveredwithperitoneum. Itpossessesaconsiderableamountofmobility,althoughitdoesnothavea mesentery. Attachedto: -Ascendingcolon -posteromediallysurfaceistheappendix,1inchbelowileocoecalvalve • • • • • • -medially Ileum Thepresenceofperitonealfoldsinthevicinityofthececumcreates Thesuperiorileocecalrecesses Theinferiorileocecalrecesses Theretrocecalrecesses. • - - -

  7. Cecum….cont •Thelongitudinalmuscleisrestrictedtothree flatbands,thetaeniacoli,whichconvergeon thebaseoftheappendixandprovideforita completelongitudinalmusclecoat.

  8. Relationsofcecum •Anteriorly: -Coilsofsmallintestine -thegreateromentum -theanteriorabdominalwallintherightiliacregion •Posteriorly: -Thepsoasandtheiliacusmuscles -thefemoralnerve -andthelateralcutaneousnerveofthethigh. -Postero-medially Theappendixiscommonly retrocecal common. •Medially: -Smallintestine(ileum)

  9. BloodSupplyofcecum Arteries •Anteriorandposteriorcecalarteries branchofSuperiormesentericartery a Theveinscorrespondtothearteriesanddrain intothesuperiormesentericvein.

  10. Bloodsupplyofcecum

  11. Venousdrainageofcecum

  12. LymphaticDrainageofcecum •Thelymphvesselspassthroughseveral finallyreachthesuperior mesentericnodes mesentericnodes.

  13. NerveSupplyofcecum •Branchesfromthesympatheticand parasympathetic(vagus)nervesformthe superiormesentericplexus.

  14. IleocecalValve Arudimentarystructure consistsoftwohorizontalfoldsofmucousmembrane Projectaroundtheorificeoftheileum. Thevalveplayslittleornopartinthepreventionofreflux ofCecalcontentsintotheileum. • • • • •Thecircularmuscleofthelowerendoftheileum(called theileocecalsphincterbyphysiologists)servesasa sphincterandcontrolstheflowofcontentsfromtheileum intothecolon. •Thesmoothmuscletoneisreflexlyincreasedwhenthe cecumisdistended;thegastrinhormone,whichis producedbythestomach,causesrelaxationofthemuscle tone.

  15. Appendix Locationand Description: •Itisanarrow,musculartube containingalargeamountoflymphoidtissue. Itvariesinlengthfrom3to5inch.(2-22cm). Thebaseisattachedtotheposteromedialsurfaceofthececum about1inch.(2.5cm)belowtheileocecaljunction. • • • •Theremainderoftheappendixisfree. •Peritoneum: -Ithasacompleteperitonealcovering,whichisattachedtothe mesenteryofthesmallintestinebyashortmesenteryofitsown, themesoappendix. -Themesoappendixcontainstheappendicularvesselsandnerves.

  16. APPENIX

  17. Appendix….cont •Position -Theappendixliesintherightiliacfossa,andinrelationtotheanterior abdominalwall 1-Retrocecalinretrocaecalrecessbehindcecum in74%ofpeople 2-pelvic:inpelvisrelatedtoRt.Ovaryanduterinetube in21%ofpeople 3-Subcaecal:belowcecum 4-Preileal:infrontofileum in3.5% 1% 5-Postileal:behindtheileum0.5% •Surfaceanatomyofappendix=McBurney'spoint -Itsbaseissituatedonethirdofthewayupthelinejoiningtheright anteriorsuperioriliacspinetotheumbilicus -Toreachtheappendixduringoperationfollowthetaeniacoliwhich convergetowardtheappendix

  18. BloodSupplyofappendix Arteries •Theappendiculararteryisabranchofthe posteriorcecalartery(ilio-cecal.a)which descendsbehindtheileum. Veins •Theappendicularveindrainsintothe posteriorcecalvein.

  19. •Appendiculararteryrunsin freemarginofthe mesoappendix

  20. LymphaticDrainageofappendix •Thelymphvesselsdrainintooneortwonodes lyinginthemesoappendix eventuallyinto thesuperiormesentericnodes.

  21. NerveSupplyofappendix •Theappendixissuppliedbythesympatheticand parasympathetic(vagus)nervesfromthe superiormesentericplexus. •Afferentnervefibersconcernedwiththe conductionofvisceralpainfromtheappendix accompanythesympatheticnervesandenterthe spinalcordatthelevelofthe10ththoracic segment. •Theperitoneumovertheappendixisinnervated bythe10thintercostalnerve=skinofumbilicus

  22. Clinicalnotes •Acuteappendetitis uncommoninthetwo extremesoflife •Thrombosisofappendicular.a gangrene(justonearteryforappendix) perforation Lt.paracolicgutterwhilein Acutecholecystitis nogangrene(morethan onearterysupplythegallbladder) •Appendiectomy

  23. AscendingColon LocationandDescription: •Theascendingcolonisabout5inch.(13cm)long •liesintherightlowerquadrant. •Itextendsupwardfromthececumtotheinferiorsurface oftherightlobeoftheliver,whereitturnstotheleft, formingtherightcolicflexure •Thenbecomescontinuouswiththetransversecolon. •Taeniacoli,sacculation&appendecesepiplolcaarepresent The peritoneum -Coversthefrontandthesidesoftheascendingcolon -Bindingittotheposteriorabdominalwall.

  24. Relationsofascendingcolon Anteriorly: Coilsofsmallintestine Thegreateromentum Theanteriorabdominalwall Posteriorly: Theiliacus Theiliaccrest Thequadratuslumborum Theoriginofthetransversus • - - - • - - - - abdominismuscle, -Thelowerpoleoftheright kidney. -Theiliohypogastric.n -Theilioinguinalnervescross behindit.

  25. Relationsofascendingcolon

  26. BloodSupplyofAscendingcolon Arteries •Theileocolic&rightcolicbranchesofthe superiormesentericarterysupplythisarea. Veins •Theveinscorrespondtothearteriesanddrain intothesuperiormesentericvein.

  27. LymphaticdrainageofAscendingcolon •Thelymphaticvessels lymphnodeslying alongthecourseofthecolicbloodvessels thesuperiormesentericnodes.

  28. Lymphaticdrainage

  29. NerveSupplyofascendingcolon •Sympatheticandparasympathetic(vagus) nervesfromthesuperiormesentericplexus.

  30. Transversecolon

  31. TransverseColon LocationandDescription •Thetransversecolonisabout15in.(38cm)long •extendsacrosstheabdomen •occupyingtheumbilicalregion. •Itbeginsattherightcolicflexurebelowtherightlobeof theliver •Hangsdownward •Suspendedbythetransversemesocolonfromthepancreas •Itthenascendstotheleftcolicflexurebelowthespleen. •Theleftcolicflexureishigherthantherightcolicflexure andissuspendedfromthediaphragmbythephrenicocolic ligament. •Taeniacoli,sacculation&appendecesepiplolcaarepresent

  32. Thetransversemesocolon=mesenteryofthe transversecolon •suspendsthetransversecolonfromthe anteriorborderofthepancreas. •Themesenteryisattachedtothesuperior borderofthetransversecolon •Theposteriorlayersofthegreateromentum areattachedtotheinferiorborder. •Thepositionofthetransversecolonis extremelyvariableandmaysometimesreach downasfarasthepelvis.

  33. RelationsofTransversecolon •Anteriorly: -Thegreateromentum -Theanteriorabdominal wall(umbilicaland hypogastricregions) •Posteriorly: -Thesecondpartofthe duodenum -Theheadofthe pancreas -Thecoilsofthe jejunumandileum

  34. BloodSupplyoftransversecolon •Arteries: -Theproximaltwothirdsaresuppliedbythemiddlecolic artery abranchofthesuperiormesentericartery. -Thedistalthirdissuppliedbytheleftcolicartery a branchoftheinferiormesentericartery. Veins -Theveinscorrespondtothearteriesanddrainintothe superior&inferiormesentericveins.

  35. LymphaticDrainageoftransverse colon •Theproximaltwothirdsdrain thecolic nodesandthenintothesuperiormesenteric nodes •Thedistalthirddrains thecolicnodes theinferiormesentericnodes.

  36. NerveSupplyoftransversecolon •Theproximaltwothirdsareinnervatedby sympatheticandvagalnervesthroughthe superiormesentericplexus •Thedistalthirdisinnervatedbysympathetic andparasympatheticpelvicsplanchnicnerves throughtheinferiormesentericplexus.

  37. DescendingColon Locationand Description: •Thedescendingcolonisabout10in.(25cm)long •Itextendsdownwardfromtheleftcolicflexure,tothe pelvicbrim,whereitbecomescontinuouswiththe sigmoidcolon. •Taeniacoli,sacculation&appendecesepiplolcaare present •Theperitoneum -Coversthefrontandthesidesandbindsittothe posteriorabdominalwall.

  38. RelationsofDescendingcolon Anteriorly: Coilsofsmallintestine thegreateromentum theanteriorabdominalwall Posteriorly: Thelateralborderoftheleftkidney theoriginofthetransversus abdominismuscle thequadratuslumborum theiliaccrest theiliacus theleftpsoas Theiliohypogastricandthe ilioinguinalnerves thelateralcutaneousnerveofthe thigh thefemoralnerve • - - - • - - - - - - - - -

  39. RelationsofDescendingcolon

  40. BloodSupplyofDescendingcolon •Arteries -Theleftcolicandthesigmoidbranchesofthe inferiormesentericartery. •Veins drain -Theveinscorrespondtothearteries intotheinferiormesentericvein.

  41. LymphaticDrainageofdescendingcolon •Lymphaticdrains thecoliclymphaticnodes &theinferiormesentericnodesaroundthe originoftheinferiormesentericartery.

  42. NerveSupplyofdescendingcolon •Thenervesupplyisthesympatheticand parasympatheticpelvic •Splanchnicnervesthroughtheinferior mesentericplexus

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