dr. ahmed fathalla ibrahim dr. jamila el- medany
TRANSCRIPT
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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
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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.
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Parts of Large IntestineParts of Large Intestine
CECUMAPPENDIXASCENDING COLONTRANSVERSE COLONDESCENDING COLONSIGMOID COLON RECTUMANAL CANAL
ABDOMENABDOMEN
PELVISPELVIS
PERINEUMPERINEUM
Abdomen
Pelvis
Perineum
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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
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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
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Peritoneal CoveringPeritoneal Covering
PARTS DEVOID OF PARTS DEVOID OF PERITONEAL PERITONEAL COVERING:COVERING:
1. Lower 1/3 of rectum
2. Anal canal
Rectum
Analcanal
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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
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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
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COLIC FLEXURES
Hepatic flexure Splenic flexure
Position: higherAngle: more acute
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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.
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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
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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
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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)
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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)
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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
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Relation Between Relation Between Embryological Origin Embryological Origin of GIT& its of GIT& its Arterial SupplyArterial Supply
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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.
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Lymph drainage of GIT• The lymph vessels follow
the arteries.• Ultimately, all the lymph
is collected at the Preaortic lymph nodes (Superior & Inferior mesenteric).
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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)
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THANK YOUTHANK YOU