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In the name of Allah
Jejunum and ileum
Rest of the small intestine From duodenojejunal flexure To ileocecal junction Intraperitoneal Attached to the posterior
abdominal wall by mesentery of small intestine
Relations- Anterior abdominal wall- Greater omentum- Posterior abdominal wall- Retroperitoneal structures
• In umbilical region of peritoneal cavity
• First 2:5 of small intestine• Diameter 4cm • Mucosal folds are large and
frequent• Thicker wall• More vascular• Redder in life• Arterial arcade less• Aggregated lymphatic follicles
are lesser• Intermesenteric fat less
• In lower part of peritoneal cavity
• Second 3:5 of small intestine• Diameter 3.5 cm• Mucosal folds are small and
few• Thinner wall• Less vascular• Paler in life • Arterial arcade more• Aggregated lymphatic
follicles are more• Intermesenteric fat more
JejunumJejunum Ileum
Ileum Ileum
Ileal or Meckel’s diverticulum Ileal or Meckel’s diverticulum
Large intestine
Large intestine
1.5 m1.5 m From caecum to anusFrom caecum to anus Includes;Includes;- Cecum and appendix Cecum and appendix - Ascending colonAscending colon- Transverse colonTransverse colon- Descending colon Descending colon - Sigmoid colonSigmoid colon- RectumRectum- Anal canalAnal canal
Large Large intestine intestine
Differs from small intestine in Differs from small intestine in the: the:
• More fixed in positionMore fixed in position• Greater caliberGreater caliber• Taeniae coliTaeniae coli• Sacculation (haustration)Sacculation (haustration)• Appendices epiploicAppendices epiploic
Cecum Cecum
In the right iliac fossaIn the right iliac fossa 6.5*7.5 cm6.5*7.5 cm Related posteriorly to the Related posteriorly to the - iliacus & psoas mm iliacus & psoas mm - lateral cutaneous N of thighlateral cutaneous N of thigh- femoral nerve femoral nerve Related anteriorly to the: Related anteriorly to the: • ant. Abdominal wallant. Abdominal wall• Small intestineSmall intestine• Greater omentumGreater omentum
Caecum Caecum
• IntraperitonealIntraperitoneal• sup. & inf. Ileucecal and sup. & inf. Ileucecal and
retrocecal recesses retrocecal recesses
ileocecal valveileocecal valve
• Sup & inf. Lip and Sup & inf. Lip and frenulumfrenulum
• Posteromedial of cecumPosteromedial of cecum• At the level of At the level of
transetubercular and transetubercular and midclavicular linesmidclavicular lines
Vermiform appendixVermiform appendix
In the right iliac fossaIn the right iliac fossa McBurney’s pointMcBurney’s point 2 cm below the ileocecal 2 cm below the ileocecal
junctionjunction Length 2-20cm average 9cmLength 2-20cm average 9cm IntraperitonealIntraperitoneal Position Position - Retrocecal & retrocolic 64%Retrocecal & retrocolic 64%- Pelvic 30%Pelvic 30%- Subcecal 2.5%Subcecal 2.5%- pre and postileal 1.5%pre and postileal 1.5%
Ascending Ascending colon colon
15 cm from cecum to hepatic flexure
Covered in front and sides by peritoneum
Taeniae coli ant., med. & lat. Relation • Posteriorly - Quadratus and iliacus- Lateral cutaneous N of thighLateral cutaneous N of thigh- Iliohypogastric - Ilio-inguinal
Ascending Ascending colon colon
Relations Relations • anteriorly anteriorly - Small intestineSmall intestine- Ant. Abdominal wallAnt. Abdominal wall- Greater omentumGreater omentum
Right or hepatic Right or hepatic flexureflexure
Turns down and forwardTurns down and forward Kidney posteriorKidney posterior Liver anterosuperior and Liver anterosuperior and
laterallateral Duodenum medialDuodenum medial Gall bladder anteromedial Gall bladder anteromedial
Transverse Transverse coloncolon
50 cm, from hepatic to 50 cm, from hepatic to splenic flexuressplenic flexures
From Rt. Lumbar From Rt. Lumbar To Lt. hypochondriumTo Lt. hypochondrium Intraperitoneal and Intraperitoneal and
attached to the post. attached to the post. abdominal wall by meso.abdominal wall by meso.
TaeniaeTaeniae
Transverse Transverse coloncolon
RelationsRelations• anterioranterior- OmentumOmentum- Ant. abdominal wallAnt. abdominal wall• posteriorposterior- PancreasPancreas- 22ndnd part of duodenum part of duodenum
Lt. colic Lt. colic flexure flexure
Higher than rightHigher than right relationsrelations- SpleenSpleen- Pancreas Pancreas - Lt. kidneyLt. kidney- Phrenicocolic Phrenicocolic
Descending colonDescending colon 25 cm 25 cm from splenic flexure to pelvic brimfrom splenic flexure to pelvic brim Two parts Two parts Covered anterioly by peritineumCovered anterioly by peritineum
Descending Descending coloncolon
Relations:Relations:• Anterior same as the right Anterior same as the right • Posterior: Posterior: - Kidney Kidney - Subcostal nerveSubcostal nerve- IliohypogastricIliohypogastric- IlioinguinalIlioinguinal- Lateral cutaneous N of thighLateral cutaneous N of thigh
Sigmoid colonSigmoid colon
25- 40 cm from pelvic 25- 40 cm from pelvic brim to S3brim to S3
Has meso.Has meso.• Lateral limb Lateral limb • Medial limb in front of Medial limb in front of
sacrumsacrum• Intersigmoid recessIntersigmoid recess
Sigmoid colonSigmoid colon
Relations Relations • PosteriorPosterior- Rectum Rectum - SacrumSacrum- UreterUreter• Anterior Anterior - UterusUterus- bladderbladder
Rectum Rectum 10-15 cm From S3 To tip of coccyx continuous
as the anal canal Piercing pelvic diaphragm Passing downward following
the curve of sacrum Deviate to the left and turns
right Rectal ampulla Anorectal angle
RectumRectum Peritonial coveringPeritonial covering Muscular coatMuscular coat Transverse foldTransverse fold
RectumRectum Relations:Relations:
Posteriorly;Posteriorly;- SacrumSacrum- CoccyxCoccyx- PiriformisPiriformis- CoccygeusCoccygeus- Lavator aniLavator ani- Sacral plexusSacral plexus- Sympathetic chain Sympathetic chain
RectumRectum
RelationsRelations
AnteriorlyAnteriorly
In male In male - Sigmoid colonSigmoid colon- IleumIleum- BladderBladder- Vas deferens Vas deferens - Seminal vesicleSeminal vesicle- prostate prostate
RectumRectum RelationsRelations
AnteriorlyAnteriorly
In femaleIn female- Sigmoid colonSigmoid colon- Ileum Ileum - Rectouterine Rectouterine
(Douglas) pouch(Douglas) pouch- Uterus Uterus - Vagina Vagina
Small and large intestine ArteryArtery- Superior mesenteric (small & Superior mesenteric (small &
large)large)- Inferior mesenteric (large)Inferior mesenteric (large)- Internal iliac (rectum & anal canal)Internal iliac (rectum & anal canal) Vein Vein - Superior mesenteric (small & Superior mesenteric (small &
large)large)- Inferior mesenteric (large)Inferior mesenteric (large)- Internal iliac (same as artery)Internal iliac (same as artery)
Anal canalAnal canal 4-5 cm4-5 cm From the rectal ampulla From the rectal ampulla To the anusTo the anus RelationsRelations
Posteriorly Posteriorly - Anococcygeal bodyAnococcygeal body
AnteriorlyAnteriorly
MaleMale- Perineal body Perineal body - Urogenital diaphragmUrogenital diaphragm- UrethraUrethra- Bulb of penisBulb of penis
Anal canalAnal canal
Female- Perineal body Perineal body - Urogenital diaphragmUrogenital diaphragm- VaginaVagina
Laterally Laterally
- Ischiorectal fossae- Ischiorectal fossae
Anal canalAnal canal Upper halfUpper half- Derived from endodermDerived from endoderm- Anal culumnsAnal culumns- Anal valvesAnal valves- Anal sinusesAnal sinuses
- Autonomic nerveAutonomic nerve- Sensitive to stretch Sensitive to stretch - Artery and vein from and to Artery and vein from and to inferior mesenteric inferior mesenteric
Anal canalAnal canal
Lower halfLower half- Derived from ectodermDerived from ectoderm- Has no anal columnsHas no anal columns- Somatic nerve, inferior rectalSomatic nerve, inferior rectal
- Sensitive to pain, Sensitive to pain, temperature, touch, pressure temperature, touch, pressure
- Art. And vein from and to Art. And vein from and to internal iliac internal iliac
- Pectinate linePectinate line
Anal canalAnal canal Muscle coat - Internal sphincter
(smooth muscle)- External sphincter
Subcutaneous
Superficial
Deep- Puborectalis- Anorectal ring
Puborectalis + internal sphincter + deep part of ext. sphincter
innervationinnervation
Autonomic Somatic- Inferior rectal
Rectum and anal canalRectum and anal canal
Blood supplyBlood supply
Arteries: Arteries: - Superior rectalSuperior rectal- Middle rectalMiddle rectal- Inferior rectalInferior rectal
Veins:Veins:- Superior rectalSuperior rectal- Middle rectalMiddle rectal- Inferior rectalInferior rectal