1. In the name of God
LARGE INTESTINE
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2. The large intestine (or colon)
Dr. Maria Zahiri
The large intestine (or colon)
the last part of the digestive system
Absorb water, sodium and some fat soluble vitamins.
The large intestine consists of :
the cecum, appendix, colon, rectum, and anal canal.
is about 4.9 feet (1.5 m) long

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4. Characteristics of large intestine
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Characteristics of large intestine
Taeniae coli: three bands of smooth muscle
Haustra : bulges caused by contraction of taeniae coli
Epiploic appendages (omental appendices ):
are small pouches of the peritoneum filled with fat and situated along the colon.
their function is unknown.

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Taeniae coli

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Epiploic appendages

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Caecum
Position: Lie in the right iliac fossa below the ileocaecal valve. Is a intraperitoneal organ (?) Posteriorly lies the retrocaecal recess which frequently contains the vermiform appendix. Size: Average 6-7 cm

8. Blood supply *Ileocolic artery Vascular supply for caecum
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Blood supply
Vascular supply for caecum
*Ileocolic artery
Superior branch
Inferior
branch
Ascending (colic) artery
Anterior caecal artery
Posterior caecal artery
Appendicular artery
Ileal artery

9. Superior branch Inferior branch Appendicular artery Ileal artery
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Ileal artery
Superior branch
Inferior branch
Appendicular artery

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11. Superior mesenteric vein
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Veins:
Superior mesenteric vein
Ileocolic vein
Superior branch
Ascending colic veins
Inferior branch
Appendicular vein
Anterior caecal vein
Posterior caecal vein
Ileal vein

12. Lymphatic drainage Anterior lymphatic vessels drain to:
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Lymphatic drainage
Anterior lymphatic vessels drain to:
Anterior ileocolic nodes
Posterior lymphatic vessels drains to:
Posterior ileocolic nodes
Inferior ileocolic nodes
To: Superior mesenteric nodes

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Innervation:
sympathetic and parasympathetic nerves via the superior mesenteric plexus.

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Vermiform appendix

15. The vermiform appendix
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The vermiform appendix
is a narrow, vermian tube
arises from the posteromedial caecal wall
it varies from 5 to 20 cm in length, 2 cm below the end of the ileum.

16. The vermiform appendix
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The vermiform appendix
It may occupy one of several positions: the commonest positions Retrocaecal (12 o’clock), retrocolic , pelvic or descending (4 o’clock) Other positions are occasionally seen especially when there is a long appendix mesentery allowing greater mobilit: subcaecal(6 o’clock) ; preilial(2 o’clock) ; postileal(2 o’clock) .

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McBurney’s point

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The three taeniae coli on the ascending colon and caecum converge on the base of the appendix, and merge into its longitudinal muscle. The anterior caecal taenia is usually distinct and can be traced to the appendix. It is connected by a short mesoappendix to the lower part of the ileal mesentery.

19. Dr. Maria Zahiri
The lumen of the appendix is small and opens into the caecum by an orifice lying below and slightly posterior to the ileocaecal opening. The orifice is sometimes guarded by a semi lunar mucosal fold forming a valve. The appendix usually contains numerous patches of lymphoid tissue although these tend to decrease in size from early adulthood.

20. VASCULAR SUPPLY Ileocolic artery Inferior branch Appendicular artery
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VASCULAR SUPPLY
Ileocolic artery
Inferior branch
Appendicular artery
accessory arteries are common

21. Dr. Maria Zahiri one or more appendicular veins posterior caecal
ileocolic vein
Superior mesenteric vein

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Lymphatic vessels
are numerous but all end in the inferior and superior nodes of the ileocolic chain.

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Innervation
sympathetic and parasympathetic nerves from the superior mesenteric plexus.

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colon
the colon consists of four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon

25. Ascending colon narrower than the caecum- 15cm
Dr. Maria Zahiri
narrower than the caecum- 15cm
It ascends to the inferior surface of the right lobe of the liver, on which it makes a shallow depression, and then turns abruptly forwards and to the left, at the hepatic flexure.
It is a retroperitoneal
Told fascia

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27. TRANSVERS COLON The transverse colon is 50 cm long
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TRANSVERS COLON
The transverse colon is 50 cm long
extends from the hepatic flexure in the right lumbar region across into the splenic flexure.
The transverse colon is suspended from the anterior border of the body of the pancreas by the transverse mesocolon.

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SPLENIC FLEXURE
forms the junction of the transverse and descending colon
lies in the left hypochondriac region anteroinferior to the lower part of the spleen
The left kidney lies behind to it

30. It lies more superiorly and posteriorly than the right hepatic flexure
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It lies more superiorly and posteriorly than the right hepatic flexure
is attached to the diaphragm at the level of the tenth and eleventh ribs by the phrenicocolic ligament which lies below the anterolateral pole of the spleen.

31. DESCENDING COLON
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25 cm
It descends through the left hypochondriac and lumbar regions
curves inferomedially to become the sigmoid colon at the inlet of the lesser pelvis.
It is a retroperitoneal structure covered anteriorly and on both sides by peritoneum.

32. SIGMOID COLON begins at the pelvic inlet and ends at the rectum(S3)
Dr. Maria Zahiri
begins at the pelvic inlet and ends at the rectum(S3)
It is completely invested in peritoneum and is attached to the posterior pelvic wall and lower posterior abdominal walls by the fan-shaped mesosigmoid.
The root of the sigmoid mesocolon has an inverted 'V‘ shape.
The position and shape of the sigmoid colon vary greatly

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Left paracolic gutter
Left ureter

34. Superior mesenteric a. Superior Middle colic a. Mesenteric v.
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Superior
Mesenteric v.
Middle colic a.
Inf. pancresticodudenal a.
Superior
mesenteric a.
Right colic a.
Jejunal and ileal a.
Ileocolic a.
Appendicular a.

35. Inferior mesenteric a. Inferior mesenteric v. Left colic a. Sigmoid a.
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Inferior mesenteric a.
Left colic a.
Sigmoid a.
Superior rectal a.

37. Colic marginal artery
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38. The Sudeck's point (or Sudeck's critical point):
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The Sudeck's point (or Sudeck's critical point):
refers to a specific location in the arterial supply of the rectosigmoid junction, namely the origin of the last sigmoid arterial branch from the inferior mesenteric artery (IMA) .
 This arterial branch usually forms an anstomosis with a branch of the superior rectal artery. 
 The anastomosis is small and often only singular.

39. The "critical point" of Sudeck is marked with an "X."
Dr. Maria Zahiri
The "critical point" of Sudeck is marked with an "X."

40. Rectum Rectum continuous with the sigmoid colon(S3)
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Rectum
Rectum continuous with the sigmoid colon(S3)
To upper end of the anal canal.
Flexure:
the sacral flexure & the perineal flexure
three lateral curves :
upper is convex to the right, the middle (the most prominent) bulges to the left, and the lower is convex to the right
Both ends of the rectum are in the median plane

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42. : 2/3anterior and 1/3lateral covered by peritoneum.
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: 2/3anterior and 1/3lateral covered by peritoneum.
the rectovesical pouch :
The peritoneum is reflected superiorly onto the urinary bladder in males
recto-uterine pouch (pouch of Douglas):
onto the posterior vaginal wall in females

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45. ARTERIES 1.superior rectal artery: upper third
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1.superior rectal artery: upper third
2.middle rectal artery: middle third (from Int. Iliac)
3.inferior rectal artery: distal third ( from Int. pudendal)

46. veins 1.internal part: below the rectal and anal epithelium
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veins
1.internal part: below the rectal and anal epithelium
2.external part: outside the muscular wall

47. veins External plexus: 1.inferior portion of the external plexus :
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External plexus:
1.inferior portion of the external plexus :
is drained by the inferior rectal vein into the internal pudendal vein
2.middle portion :
by a middle rectal vein into the internal iliac vein,
3.superior part :
By a superior rectal vein, which is the start of the inferior mesenteric vein. Communication between portal and systemic venous systems is thus established in the rectal plexus.

48. Internal plexus& External plexus:

49. Lymph

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