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ecQeiLze. New Five Year Program. GIT Module. 1. Armed Forces College of Medicine AFCM.

New Five Year Program. GIT Module. 2. Large Intestine Dr. Shereen Adel.

New Five Year Program. GIT Module. 3. INTENDED LEARNING OBJECTIVES (ILO).

Differences between small & large intestine Parts of large intestine Blood Supply & lymphatic drainage of large intestine.

It begins at end of ileum & Ends at anal orifice ( 1.5 meters) It consists of cecum, ascending colon , right colic flexure ,transverse colon, left colic flexure , descending colon, pelvic colon, rectum & anal canal. Larger than small intestine , less mobile & peripheral in position.

Anatomy Department. 6. Transverse cobn IEurn Apperxiix.

Image30. Caecum. Ascending colon. Transverse colon.

The wall shows: Taeniae coli :3 bands of longitudinal muscle layer, they begin at base of appendix & terminate at sigmoid colon Sacculations : bulging in wall of colon because the length of taeniae coli is shorter than length of colon Appendices epiploicae : peritoneal folds filled with fat , Absent in c aecum , a ppendix & r ectum.

Image33. Appendices epiploicae. Sacculations. Taeniae coli.

Friday, 18 December, 2020. Anatomy Department. 10.

While performing exploratory laparotomy in a patient with firearm injury to the abdomen, the surgeon says “Oh, the bullet has perforated the large bowel!”. 1. Characteristics that could enable the surgeon to identify the large bowel include …………………………..,…………………………….&……………….

It is a blind pouch that lies in right iliac fossa , 6 cm in length Continuous upwards with ascending colon Receives opening of ileum and appendix in its posteromedial aspect Completely covered by peritoneum.

showimage. Coils of SI. Greater omentum. Relations : Anterior: Anterior abdominal wall Coils of small intestine Greater omentum.

Quadratus lumborum. Iliacus. Psoas major. New Five Year Program.

Iliohypogastic. Ilioinguina l. Lateral cutaneous nerve.

. Iliacus & lateral cutaneous nerve of thigh Psoas & genitofemoral nerve Between psoas and iliacus lies the femoral nerve Right gonadal & right external iliac vessels Retro- caecal recess of peritoneum, with the appendix..

showimage. Right external iliac. . New Five Year Program.

showimage. Ileocaecal valve : Valve has 2 lips that join at sides to form frenula Sphincter is derived from circular layer of ileum..

A narrow worm like tube 2- 20 cm, it lies in right iliac fossa Opens in postero - medial aspect of caecum 2 cm below the ileo caecal junction 3 Taenia coli meet at base of appendix.

showimage. Different positions Retro ceacal : 65% behind caecum in retrocaecal recesss Pelvic: 31% hangs in relation to ovary & uterine tube Sub ceacal : 2.5% below caecum Pre ileal : 1% in front terminal part of ileum Post ileal : 0.5% behind terminal part of ileum.

In acute appendicitis pain is referred to the umbilicus???.

showimage. Meso appendix. Meso appendix : Mesoappendix is triangular in shape & has a base & 2 borders 1- Base attached to back of lower part of mesentery 2- One border contains appendix 3- Other border is free containing appendicular vessels.

Note:. -Acute appendicitis leads to thrombosis of the appendicular artery that results in gangrene and perforation of the appendix..

Extends from cecum till inferior surface of liver Covered by peritoneum front & sides Anterior relations …… like caecum Posterior relations Iliacus & lateral cutaneous nerve of thigh Iliac crest & iliolumbar ligament Quadratus lumborum & iliohypogastric & ilioinguinal nerves Origin of transversus abdominus Right kidney.

showimage. Right colic flexure is related to right lobe of liver anteriorly.

Extends from right colic to left colic flexure It has mesentery called transverse mesocolon Contents of transverse Mesocolon : Transverse colon Middle colic artery Sympathetic fibers, extraperitoneal fatty tissue & lymph nodes.

Anterior relations : posterior 2 layers of greater omentum Posterior relations : 2nd part of duodenum Head of pancreas Duodeno jejunal junction & coils of small intestine Left kidney.

Superior Relations : Liver and gall bladder Greater curvature of stomach Lateral end of spleen Inferior Relations : Coils of intestine.

Covered by peritoneum except posterior It is related to left kidney , tail of pancreas & spleen posteriorly Attached to diaphragm by phrenico -colic ligament Left colic flexure is More acute Higher than right colic flexure.

From left colic flexure down to pelvic inlet Covered by peritoneum from front & sides Anterior relations ?????? As ascending colon Posterior Relations : Left kidney. Origin of transvers abdominus Quadratus lumborum & subcostal, iliohypogastric & ilioinguinal nerves 4. Iliacus &…… 5. Psoas &…… 6. Femoral nerve between ………… 7. Left gonadal & left external iliac artery.

It begins at pelvic brim Ends at 3 sacral piece to become continuous as rectum It forms a loop that descends downwards on plevic wall in contact with Left external iliac vessels Left obturator nerve Vas in males or ovary in females Then the pelvic colon crosses pelvic Cavity horizontal.

Pelvic Mesocolon. It has free border that encloses pelvic colon Attached border: inverted V shaped Contents Pelvic colon Superior rectal artery Sigmoid artery Sympathetic fibers, extraperitoneal fatty tissue& lymph nodes.

Which part of the abdominal viscera lies retroperitoneal? a. Jejunum b. Ileum c. Ascending colon d. Transverse colon e- Pelvic colon.

New Picture (9). Do you remember posterior relations of large intestine??????????.

Parts of the colon that are completely covered by peritoneum include……………………………,……………………………..,……………………………..&…………………………………………...

showimage. Branches of superior mesenteric artery till the junction of right two thirds of transverse colon.

showimage. Transverse colon : left 1/3 by left colic artery Left colic flexure : by left colic Descending colon : left colic &upper sigmoid arteries Pelvic colon: sigmoid arteries.

showimage. Venous drainage : superior & inferior mesenteric veins.

Lymphatic Drainage. 1- Epicolic LN : on the wall of colon 2- Paracolic LN : on medial borders of ascending & descending colon & mesenteric border of transverse colon 3- Intermediate LN : along ileocolic , middle colic, right colic , left colic & sigmoid arteries 4- Terminal colic LN: along trunks of superior & inferior mesenteric.

showimage. Quiz 3 ( blood supply & lymphatic drainage).

Features of large intestine Different parts of large intestine ( shape, size, relations & peritoneal covering) Blood supply & lymphatic drainage of large intestine.

Clinical Anatomy by regions, Richard Snell, 9 th . Edition pages 180- 184. Atlas of human anatomy, Frank Netter, 4 th . Edition plates 269- 271..

43. New Five Year Program. GIT Module. Thank you.