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Dr. Ahmed Fathalla Dr. Ahmed Fathalla IbrahimIbrahimDr. Ahmed Fathalla Dr. Ahmed Fathalla IbrahimIbrahim
Dr. Jamila El-Dr. Jamila El-MedanyMedanyDr. Jamila El-Dr. Jamila El-MedanyMedany
OBJECTIVESOBJECTIVESAt the end of the lecture, students should:At the end of the lecture, students should:List the different parts parts of large intestine.List the characteristic features of colon.Describe the anatomy of different parts of different parts of
large intestine large intestine regarding: the surface anatomy, peritoneal covering, relations, arterial & nerve supply.
Parts of Large IntestineParts of Large Intestine
CECUMAPPENDIXASCENDING COLONTRANSVERSE COLONDESCENDING COLONSIGMOID COLON RECTUMANAL CANAL
ABDOMENABDOMEN
PELVISPELVIS
PERINEUMPERINEUM
Abdomen
Pelvis
Perineum
Characteristics of COLONCharacteristics of COLON(NOT FOUND IN RECTUM & ANAL CANAL(NOT FOUND IN RECTUM & ANAL CANAL
1.1. Taeniae coli:Taeniae coli: (3) longitudinal muscle
bands 2.2. Sacculations Sacculations
(Haustra):(Haustra): Because the Taeniae coli
are shorter than large intestine
3. Epiploic Appendices :3. Epiploic Appendices : Short peritoneal folds filled with fat
Peritoneal CoveringPeritoneal Covering
PARTS WITH PARTS WITH MESENTERY:MESENTERY:
1. Transverse colon2. Sigmoid colon3. Appendix4. Cecum RETROPERITONEAL RETROPERITONEAL
PARTS:PARTS:1. Ascending colon2. Descending colon3. Upper 2/3 of
rectum
Peritoneal CoveringPeritoneal Covering
PARTS DEVOID OF PARTS DEVOID OF PERITONEAL PERITONEAL COVERING:COVERING:
1. Lower 1/3 of rectum
2. Anal canal
Rectum
Analcanal
Anterior Relations of (CECUM – Anterior Relations of (CECUM – ASCENDING & DESCENDING COLONS)ASCENDING & DESCENDING COLONS)
Greater omentum
Coils of small intestine
Greater omentum
Coils of small intestine
Anterior abdominal wallAnterior abdominal wall
Posterior Relations (CECUM – ASCENDING Posterior Relations (CECUM – ASCENDING & DESCENDING COLONS)& DESCENDING COLONS)Cecum:Cecum:1.Psoas major2.IliacusAscending colon:Ascending colon:1.Iliacus2.Quadratus lumborum3.Right kidney.Descending colon:Descending colon:1.Left kidney2.Quadratus lumborum3.Iliacus
Quadratus lumborum
COLIC FLEXURES
Hepatic flexure Splenic flexure
Position: higherAngle: more acute
Relations of Transverse ColonRelations of Transverse ColonAnteriorAnterior: : greater omentum, anterior abdominal wallAnteriorAnterior: : greater omentum, anterior abdominal wall
PosteriorPosterior:: 2nd part of duodenum , pancreas & superior mesenteric vessels.
PosteriorPosterior:: 2nd part of duodenum , pancreas & superior mesenteric vessels.
Relations of Transverse ColonRelations of Transverse Colon
Superior:Superior: liver, gall bladder, stomachSuperior:Superior: liver, gall bladder, stomach
Inferior: Inferior: coils of small intestineInferior: Inferior: coils of small intestine
APPENDIXAPPENDIX
• Surface anatomy:Surface anatomy:• the base of appendix is
marked by Mc’Burney’s Mc’Burney’s pointpoint: :
• A point at the junction of lateral 1/3 & medial 2/3 of a line traced from right anterior superior iliac spine to umbilicus
APPENDIXAPPENDIX Opening:Opening: At posteromedial
aspect of cecum, 1 inch below ileo-cecal junction
Positions:Positions:1.Retrocecal :1.Retrocecal :(most
common) 2.Pelvic2.Pelvic3.Subcecal3.Subcecal4.Preilieal4.Preilieal5.Postileal:5.Postileal: least common
(5)
(3)
(1)
(4)
(2)
RECTUMRECTUMBeginning:Beginning: as a continuation of sigmoid colon at level of at level of S3.S3.Termination: Termination: continues as anal canal, one inch one inch below & in front of tip of below & in front of tip of coccyx.coccyx. Its end is dilated to form the rectal ampulla.Length: Length: 13 cm(5 inches)
Relations of Rectum in PelvisRelations of Rectum in PelvisMALE PELVISMALE PELVIS
Anterior:Anterior: seminal vesicles, posterior surfaces of urinary bladder & prostate glandPosterior:Posterior: sacrum, sacral plexus & coccyx
FEMALE PELVISFEMALE PELVISAnterior:Anterior: posterior wall of vaginaPosterior:Posterior: sacrum , sacral plexus & coccyx
RR RR
Relation Between Relation Between Embryological Origin Embryological Origin of GIT& its of GIT& its Arterial SupplyArterial Supply
VENOUS DRAINAGE OF GIT
• The veins of the gut form the tributaries of the portal vein which enters the liver and drains into the portal circulation.
Lymph drainage of GIT• The lymph vessels follow
the arteries.• Ultimately, all the lymph
is collected at the Preaortic lymph nodes (Superior & Inferior mesenteric).
RELATION BETWEEN RELATION BETWEEN EMBRYOLOGICAL ORIGIN & NERVE EMBRYOLOGICAL ORIGIN & NERVE
SUPPLYSUPPLY Origin: Midgut (endoderm) Nerve supply: (Autonomic):• Sympathetic + Vagus Origin: Hindgut (endoderm) Nerve supply: (Autonomic): • Sympathetic + pelvic
splanchnic nerves Origin: Origin: ectoderm (lower 1/3 of ectoderm (lower 1/3 of
anal canal)anal canal) Nerve Supply: Nerve Supply: SomaticSomatic (inferior (inferior
rectal)rectal)
THANK YOUTHANK YOU