Professional Documents
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Dr. Hermizi Hapidin School of Health Sciences Health Campus Universiti Sains Malaysia hermizi@kck.usm.my h i i@k k 1st March 2012
OBJECTIVES:
At the end of this lecture, the students should understand: ,
a) b) c) d) e) f) g) h)
Embryology of digestive system Subdivisions of large intestine Anatomy of cecum & appendix Anatomy of colon (ascending, transverse, descending & sigmoid) Anatomy of rectum Anatomy of anal canal Histology of large intestine Blood supply of large intestine pp y g
GUT
4th week of development, cells of endoderm form cavity called primitive gut
a) b) c)
Foregut
develops into pharynx, esophagus, stomach & part of duodenum (1st & 2nd parts)
ileum & portions of large intestine (cecum, appendix, ascending colon & right 2/3 of pp , g g transverse colon)
, g , g transverse colon, descending colon, sigmoid colon & rectum), except for portion of anal canal (derived from proctodeum)
FOREGUT
Celiac trunk
MIDGUT
The boundaries of the foregut, midgut and hindgut are determined by their respective blood supply
DIVISION FOREGUT
ARTERY
CELIAC ARETERY
VEIN
PORTAL VEIN Spleenic vein Gastric vein SUPERIOR MESENTERIC VEIN
LYMPHATICS
CELIAC NODES
SYMPATHETIC PARASYMPATHETIC
CELIAC GANGLIA VAGUS
MIDGUT
VAGUS
HINDGUT
INFERIOR MESENTERIC ARTERY INFERIOR MESENTERIC VEIN
Parotid gland Sublingual gland Salivary Submandibular glands gland Pharynx Stomach Pancreas (Spleen) Transverse colon Descending colon Ascending colon Cecum Sigmoid colon Rectum Vermiform appendix Anal canal
Esophagus
Large intestine
Anus
LARGE INTESTINE
General description p Terminal portion Extends from ileum to the anus Length: It is about 1.5 meters l h b long Diameter: 6.5 cm Attached to posterior abdominal wall by its mesocolon Can be distinguished from small intestine by :
Teniae coli (3 thickened bands of muscles cecum & colon) H Haustra ( t (sacculations of colon b t l ti f l between t i ) teniae) Omental appendices (small fatty projections of omentum) Caliber (internal diameter is much larger)
LARGE INTESTINE
Teniae coli
LARGE INTESTINE
Teniae coli are three thickened band formed by longitudinal fibers of smooth muscle in muscular coat of large intestine extending from vermiform appendix to rectum th they are visible and can b seen i ibl d be on outside surface of ascending, transverse, descending & sigmoid colons teniae coli contracts length wise to produce haustra (bulges in colon)
Haustra Teniae coli
Ascending colon
Descending colon
Cecum
Anal canal
colon Blind-ended pouch that is situated in right iliac fossa & rest in iliacus muscle It is about 6 cm long & completely covered with peritoneum Attached to its posteromedial surface is the appendix
Ileum
Mesoappendix
Appendicular artery
Cecum
Appendix
Drawing of interior of cecum showing endoscopic appearance of ileocecal valve, ileocecal orifice & opening of vermiform appendix
co o ( ood pa ag ) colon (= food passage) Is divided into 4 parts : a) Ascending b) T Transverse c) Descending d) Sigmoid ) g
Transverse
Ascending
Descending
Sigmoid
a) Ascending Colon
It is about 13 cm long Situated in right lower quadrant
(right lumbar region) It extends f t d from cecum t under to d surface of liver, where it turn to g left & form right colic flexure or hepatic flexure and continuous with transverse colon Is narrower than cecum Lies retroperitoneally along right p side of posterior abdominal wall
b) Transverse Colon
It is about 38 cm long Is the largest & most mobile part of
Spleen
large intestine Extends across abdomen & occupying umbilical region It begins at right colic flexure It hangs downward & suspended by b transverse mesocolon l Then, ascends to left colic flexure or splenic flexure below spleen p p (where it bends inferiorly to become descending colon Left colic flexure is higher but less mobile than right colic flexure
Transverse colon
Descending colon
b) Transverse Colon
Transverse (fold of peritoneum, mesocolon which connects the
c) Descending Colon
It is about 25 cm long Lies
in left upper & lower upp o quadrants (left lumbar region) It extends downward from left colic flexure to pelvic brim where it becomes continuous with sigmoid colon P i Peritoneum covers anterior & i lateral sides and binds it to posterior abdominal wall
1. Sacrum 2. Ilium 3. Ischium 4. Pubic bone 5. Pubic 5 P bi symphysis h i 6. Acetabulum 7. Foramen obturator 8. Coccyx
Descending colon
Sigmoid colon
Red line: Pelvic inlet/pelvic brim (the upper limit of the pper pelvic cavity)
d) Sigmoid Colon
It is about 25 - 38 cm long g It
begins as a continuation of descending colon in front of pelvic brim Below, it becomes continuous with rectum in front of third sacral vertebra (S3 vertebra) t b t b ) It is mobile & hang down into pelvic cavity in form of a loop Is attached to posterior wall by fanshaped sigmoid mesocolon It lies in pelvic cavity = pelvic colon
Transverse colon
d) Sigmoid Colon
Greater omentum Transverse colon Transverse mesocolon Descending colon Jejunum Jej n m Mesentery Sigmoid mesocolon Sigmoid colon Ileum
as a continuation of sigmoid colon It passes downward, following curve of sacrum & coccyx It ends in front of tip of coccyx by piercing pelvic diaphragm & becomes continuous with anal canal
Sagittal view
to form rectal ampulla (where feces are stored until they are eliminated via the anal canal) Has three lateral curvatures : Upper curve - convex to right Middle curve - convex to left Lower curve - convex to right
Ampulla of rectum
Upper curve
covers anterior & lateral surfaces of upper third of rectum & only anterior surface of middle third Lower third of rectum devoid of peritoneum Muscular coat is arranged in outer longitudinal & inner circular layers of smooth muscle th l Taenia coli (sigmoid colon) come together, so that longitudinal fibers form a broad band on ant & post surfaces of rectum Mucous membrane together with circular y muscle layers forms transverse folds of rectum (semicircular permanent folds)
Rectal valve
passes downward & backward from rectal ampulla to anus It surrounded by internal and external anal sphincters Its lateral walls are kept in p apposition by levator ani muscles & anal sphincters
Anal canal
Hemorrhoidal veins Levator ani muscle Internal anal sphincter External anal sphincter
Anus
Anal sinuses
Anal columns
Rectum
Rectal valve
Anal canal
Hemorrhoidal veins Levator ani muscle Internal anal sphincter External anal sphincter
Anus
Anal sinuses
Anal columns
superficial
h has b bony attachment tt h t
deep
encircles
ANAL SPHINCTERS
Rectal valve Rectum Hemorrhoidal veins Levator ani muscle Anal canal External anal sphincter Internal anal I t l l sphincter Anal columns Pectinate line Anal sinuses Anus
Internal anal sphinctersmooth muscle External anal sphincterskeletal muscle
Sigmoid colon Teniae coli (free taenia) Fibers of taenia spread to form longitudinal muscle of rectum Fibers from longitudinal muscle join circular muscle layer Circular muscle layer underlying longitudinal layer Levator ani muscle
Deep p Superficial Subcutaneous
Rectum
Anal canal
Perineal skin
Mucosa b) Submucosa c) Muscularis d) Serosa Mucosa consists of epithelium, lamina propria with intestinal glands (crypts of Lieberkuhn) & muscularis mucosae Submucosa consists of areolar CT Muscularis consists of external layer of longitudinal smooth muscle & internal layer of circular smooth muscle (portion of longitudinal muscles are thickened & forming teniae coli) Serosa layer of large intestine is part of visceral peritoneum (small pouches of visceral peritoneum filled with fat are attached to teniae coli = epiploid appendages)
a)
Crypts of Lieberkuhn (intestinal glands) are simple, tubular glands which arise as evaginations into the mucosa of the intestine (small and large intestine)
Villi are absent and the crypts appear deeper than the ones you observed in small intestine. Goblet cells are numerous
Ileum Il
Colon
Ileocolic artery
Appendicular artery
Appendix
Ascending colon
sigmoid inferior
Descending colon
arteries inferior
Sigmoid arteries
Sigmoid colon
Cystic vein
PORTAL VEIN
Rectum
Anal canal
Arteries
Veins