Anatomy the small and large intestine.pptx

Lecture notes for medical students

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2. The small and Large Intestine

3. The small and Large Intestine ANATOMY

4. Small Intestine

5. Small Intestine one of the most important organs for digestion, absorption and immune defense largest endocrine organ of the body Starts from the pylorus and ends at the cecum 3 parts: Duodenum (20cm) Jejunum (100 to 110cm) Ileum (150 to 160 cm)

6. Duodenum - The duodenum is situated in the epigastric and umbilical regions Right lobe of liver Falciform ligament Gallbladder Pancreas Duodenum L-3

7. duodenum

8. duodenum The duodenum is a c-shaped Concave tube About 10” in length. It joins the stomach to the jejunum. It curves around the head of the pancreas to the left and backwards. It is important because it receives the opening of the bile and pancreatic ducts.

9. duodenum….cont Most of the duodenum is retroperitoneal except the 1 st inch & last inch This short segment( 1 st inch) has the lesser omentum on its upper border, the greater omentum on its lower border, and the lesser sac posterior to it The duodenum extends from the pylorus to the jejunum It is divided into 4 parts.

10. Parts of the duodenum & Their relations

11. Parts of the duodenum &Their relations

12. Parts of the duodenum &Their relations

13. 1 st part of Duodenum

14. 1 st part of Duodenum - The first part is 2 inches long. It begins from the pyloduodenal junction At the level of the transpyloric line Runs upward and backward at the level of the 1 st lumbar vertebra 1 inch to the right.

15. Relations of 1 st part of doudenum Ant. The liver (quadratus lobe) gall bladder

16. Relations of 1 st part of duodenum……cont Sup. - the epiploic foramen

17. Relations of 1 st part duodenum……cont post. - The lesser sac - gastroduodenal Artery - the Bile duct portal vein I.V.C Inf. The head of the pancreas.

18. 2 nd part of duodenum

19. 2 nd part of duodenum It is 3”(3 inch) long runs downward vertically on the right side In front of the Rt.kidney next to the 3 rd and 4 th lumbar vertebrae. halfway of it, The bile duct and the main pancreatic duct pierce the medial wall, and then form the ampulla that opens in the major duodenal papilla . The accessory pancreatic duct (if present) opens in the minor duodenal papilla more superiorly.

20. Hepaticopancreatic ampulla (Ampulla of Vater)

21. Hepaticopancreatic ampulla (Ampulla of Vater)

22. Relations of2 nd part of duodenum

23. Relations of2 nd part of duodenum Ant. The gallbladder (fundus) Right lobe of the liver Transverse colon coiled of small intestine. Post. Hilum of Rt. Kidney Rt. Ureter. Lateral. Right colic flexure Ascending colon Right lobe of the liver. Medial. - Head of pancreas - Bile and pancreatic ducts.

24. 3 rd part of duodenum

25. 3 rd part of duodenum 4” long Runs horizontally to the left On the subcostal plane. Runs in front of the vertebral column Under the lower margin of the head of pancreas Above the coils of the jejunum.

26. Relations of 3 rd part of duodenum Anteriorly: - The root of the mesentery of the small intestine - the superior mesenteric vessels contained within the mesentry coils of jejunum Posteriorly: The right ureter the right psoas muscle the inferior vena cava the aorta Superiorly: The head of the pancreas Inferiorly: Coils of jejunum

27. 4 th part of duodenum…..cont

28. 4 th part of duodenum…..cont 1” long Runs upward to the left End in the duodenojejunal junction at the level of the 2 nd lumbar vertebrae 1” to the left. The junction (flexure) is held in position by the ligament of Treitz , which is attached to the right crus of the diaphragm (duodenal recess).

29. Relation of 4 th part of duodenum Ant. - The beginning of the root of the mesentery - coils of the jejunum. Post. - Lt. psoas major - the sympathetic chain left margin of the aorta. Sup. - Uncinate process of the pancreas.

30. Blood supply of duodenum

31. Blood supply of duodenum Arteries 1- upper half (1 st part + upper1/2 of 2 nd part) is supplied by the superior pancreaticoduodenal artery , a branch of the gastroduodenal artery . 2- The lower half (lower ½of 2 nd part +3 rd +4 th part) is supplied by the inferior pancreaticoduodenal artery , a branch of the superior mesenteric artery

32. Veins of duodenum

33. Veins of duodenum The superior pancreaticoduodenal vein drains into the portal vein The inferior vein joins the superior mesenteric vein .

34. Lymphatic drainage

35. Lymphatic drainage The lymph vessels follow the arteries drain upward  via pancreaticoduodenal nodes  the gastroduodenal nodes  the celiac nodes drain downward  via pancreaticoduodenal nodes  the superior mesenteric nodes around the origin of the superior mesenteric artery.

36. Nerve supply

37. Nerve supply Sympathetic nerve Parasympathetic nerves from vagus. Via 1- The celiac plexus 2- Superior mesenteric plexus.

38. Jejunum and Ileum Location and Description

39. Jejunum and Ileum Location and Description The jejunum and ileum measure about 20 ft (6 m) long the upper two fifths is the jejunum & the lower 3/5 is the ileum Each has distinctive features there is a gradual change from one to the other The jejunum begins at the duodenojejunal flexure the ileum ends at the ileocecal junction . The coils of jejunum and ileum are freely mobile and are attached to the posterior abdominal wall by a fan-shaped fold of peritoneum known as the mesentery of the small intestine

40. mesentery of the small intestine

41. mesentery of the small intestine fan-shaped fold of peritoneum The long free edge of the fold encloses the mobile intestine. The short root of the fold is continuous with the parietal peritoneum on the posterior abdominal wall Along a line that extends downward and to the right from the left side of the second lumbar vertebra to the region of the right sacroiliac joint

42. Root of the mesentery

43. Root of the mesentery

44. Difference between Jejunum & Ileum Ileum jejunum Distal 3/5 Proximal 2/5 length in the lower part of the cavity and in the pelvis in the upper part of the peritoneal cavity below the left side of the transverse mesocolon site Thinner & less redder thicker wall& redder wall numerous short terminal vessels arise from a series of three or four or even more Arcade - Short vase recta simple ,only one or two arcades with long infrequent branches Long vase recta Arcades in mesentery - the fat is deposited throughout mesentery - Big amount - No window appear - the fat is deposited near the root - it is scanty near the intestinal wall - Less in amount  appear window Fat in mesentery

45. Difference between Jejunum & Ileum Ileum jejunum smaller wider Diameter Less numerous numerous villi they are: 1- smaller 2- more widely separated 3- in the lower part they are absent . They are: 1- larger 2- more numerous 3- closely set Plicae circularis(the permanent enfolding of the mucous membrane& submucosa Aggregations of lymphoid tissue (Peyer's patches) are present in the mucous membrane No or few Lymphatic follicles

46. Blood supply of Jejunum & Ileum

47. Blood supply of Jejunum & Ileum Arteries: The arterial supply is from branches of the superior mesenteric artery . The intestinal branches arise from the left side of the artery and run in the mesentery to reach the gut. They anastomosis with one another to form a series of arcades . The lowest part of the ileum is also supplied by the ileocolic artery.

48. Veins: The veins correspond to the branches of the superior mesenteric artery Drain into the superior mesenteric vein.

49. Lymphatic Drainage of jejunum & ileum

50. Lymphatic Drainage of jejunum & ileum The lymph vessels pass through many intermediate mesenteric nodes Finally reach the superior mesenteric nodes  around the origin of the superior mesenteric artery.

51. Nerve Supply of jejunum & Ileum

52. Nerve Supply of jejunum & Ileum The nerves are derived from the sympathetic and parasympathetic (vagus) Nerves from the superior mesenteric plexus.

53. Congenital anomaly of small intestine

54. Congenital anomaly of small intestine Meckel's Diverticulum: a congenital anomaly of the ileum Present in 2% of people 2 feet from iliocecal junction 2 inch long contains gastric or pancreatic tissue Remains of vitelline duct of embryo

55. Meckel's Diverticulum

56. Anatomical Position of Large Intestine

57. Gross Anatomy of Large Intestine

58. Gross Anatomy of Large Intestine Subdivided into Cecum, vermiform appendix, colon, rectum, anal canal Special features of large intestine Teniae coli Thickening of longitudinal muscularis Haustra Puckering created by teniae coli Epiploic appendages Fat-filled pouches of visceral peritoneum

59. Copyright © 2008 Pearson Education, Inc., publishing as Benjamin Cummings Gross Anatomy of Large Intestine Cecum Blind pouch Beginning of large intestine Vermiform appendix Contains lymphoid tissue Neutralizes pathogens Colon Divided into distinct segments Ascending, transverse, descending, and sigmoid colon

60. Cecum

61. Cecum Part of large gut below ic junction About 6cm in length. Completely covered with peritoneum. Three tenia coli converge to the base of appendix.

62. Cecum: Relations Anterior Coils of small intestine Greater omentum Anterior Abdominal wall. Posterior The ilacus muscle Iliac creast Lateral cutaneous nerve of thigh Femoral Nerve Usually appendix

63. Ascending Colon

64. Ascending Colon Extends from cecum to hepatic flexure. About 13cm inlength.

65. Ascending Colon Extends from cecum to hepatic flexure. About 13cm inlength.

66. Ascending Colon:Relations Anterior Coils of small intestine Greater omentum Anterior Abdominal wall. Posterior The ilacus muscle Iliac creast Quadratus lumborum muscle Transversus abdominis origin Lower pole of right kidney Ilohypogastric and ilioinguinal nerves

67. Vermiform Appendix

68. Vermiform Appendix Finger like projection from posteromedial aspect of cecum 8 13 cm. Lies freely in peritoneal cavity. Tip is variable Has a mesentry. McBurney’s point Appendicular artery.

69. Transverse Colon:Relations

70. Transverse Colon:Relations Anterior Greater omentum Anterior Abdominal wall. Posterior Second part of duodenum Head of pancreas Coils of jejunum and ileum.

71. Descending Colon

72. Descending Colon Extends from splenic flexure to pelvic brim About 25cm in length.

73. Descending Colon:Relations Anterior Greater omentum Coils of jejunum and ileum. Anterior Abdominal wall. Posterior The iliopsoas muscle Iliac creast Quadratus lumborum muscle Transversus abdominis origin Lateral border of left kidney Ilohypogastric and ilioinguinal nerves Lateral cutaneous nerve of thigh Femoral Nerve

74. Sigmoid Colon

75. Sigmoid Colon Extends at pelvic brim. Continuation of descending colon About 25 to 38cm in length. Continues into Rectum Hangs as a loop. Sigmoid mesocolon. Appendices epiploicae.

76. Sigmoid Colon:Relations Anterior In male Urinary bladder. In female: Uterus and upper part of vagina. Posterior Rectum and sacrum Depended coils of samll gut.

77. Sigmoid mesocolon Fan shaped. Root is attached to posterior wall. Root is shaped inverted V. Behind the root of Sigmoid mesocolon lies Left ureter and bifurcation of left common ilias artery.

78. Referred Pain

79. Referred Pain Tip of shoulder. Periumbilical Hypogastrium.

80. MCQ

81. MCQ 1.Bile duct opens into the (Karn. 94) Second part of duodenum Third part of duodenum Pyloric end of stomach Ileo - caecal junction

82. MCQ 1.Bile duct opens into the --(Karn. 94) Second part of duodenum Third part of duodenum Pyloric end of stomach Ileo - caecal junction

83. MCQ 2. All of the statements are true about ileum except : (PGI 1998 ) LN in mesentery B. 1-6 arcades in continuation Smaller diameter than jejunum Large circular mucosal folds

84. MCQ 2. All of the statements are true about ileum except : (PGI 1998 ) LN in mesentery B. 1-6 arcades in continuation Smaller diameter than jejunum Large circular mucosal folds

85. MCQ 3. The blood supply of the jejunum is through the ‑ (PGI 88) Inferior mesenteric artery Superior mesenteric artery Pancreatico duodenol artery Ileocolic artery

86. MCQ 3. The blood supply of the jejunum is through the ‑ (PGI 88) Inferior mesenteric artery Superior mesenteric artery Pancreatico duodenol artery Ileocolic artery

87. MCQ 4. The inferior mesentric artery supplies all of the following organs except-- (DNB 91) a) Ascending colon b) Descending colon c) Transverse colon d) Sigmoid colon

88. MCQ 4. The inferior mesentric artery supplies all of the following organs except-- (DNB 91) a) Ascending colon b) Descending colon c) Transverse colon d) Sigmoid colon

89. 6. In portal hypertension the sites of portosystemic anastomosis includes - (AIIMS 87) Lower end of esophagus Around umbilicus - Lower third of rectum and anal canal Extraperitoneal surface of abdominaL organs All of the above

90. 6. In portal hypertension the sites of portosystemic anastomosis includes - (AIIMS 87) Lower end of esophagus Around umbilicus - Lower third of rectum and anal canal Extraperitoneal surface of abdominaL organs All of the above

91. 7. True statement about upper half anal canal is .AI 1998 A. Insensitive to pain B. Drained by superficial inguinal lymph node C. Lined by squamous epithelium D. Supplied by superior mesentric artery

92. 7. True statement about upper half anal canal is .AI 1998 A. Insensitive to pain B. Drained by superficial inguinal lymph node C. Lined by squamous epithelium D. Supplied by superior mesentric artery

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