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LargeIntestine

Thelargeintestineextends
fromtheileocecaljunction
totheanusandisabout
1.5mlong.Onthesurface,
youcanidentifybandsof
longitudinalmusclefibers
calledtaeniaecoli,each
about5mmwide.There
arethreebandsandthey
startatthebaseofthe
appendixandextendfrom
thececumtotherectum.
Alongthesidesofthe
taeniae,youwillfindtags
ofperitoneumfilledwith
fat,calledepiploic
appendages(or
appendicesepiploicae).
Thesacculations,called
haustra,arecharacteristic
featuresofthelarge
intestine,anddistinguishit
fromtherestofthe
intestinaltract.
Thelargeintestineconsists
ofthefollowingparts:
1.cecum
2.ascendingcolon
3.transversecolon
4.descendingcolon
5.sigmoidcolon
6.rectumNotseenin
diagram.
7.analcanalNotseenin
diagram.
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8.anusNotseenin
diagram.
Therearetwoflexures
associatedwiththecolon:
1.rightcolicflexureor
hepaticflexure
2.leftcolicflexureor
splenicflexure

Thececumis
about6cmlong
andisablindcul
desacwhichlies
intherightiliac
fossa.Itisthe
partofthecolon
belowthe
openingofthe
ileumintothe
colon.Thececum
liesimmediately
behindthe
abdominalwall
andgreater
omentum.There
isfrequentlya
peritonealrecess
behindthececum
calledthe
retrocecalrecess
andtheappendix
issometimes
hidingwithinthis
recessandmay
extendasfar
superiorlyasthe
liver.
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Hangingoffthe
cecumisthe
vermiform
appendixwhich
opensintothe
cecumabout2cm
belowthe
ileocecalopening.
Theaverage
lengthofthe
appendixisabout
10cmandmaylie
indifferent
positions.Ithas
itsown
mesenterycalled
the
mesoappendix
whichcarriesthe
appendicular
artery.

Ifthececumis
opened,youcan
identifythe
openingofthe
ileumintothe
cecum.This
openingis
surroundedby
thickenedmuscle
whichformsthe
iliocolicvalve.In
thisimage,you
canseethefirst
partofthe
ascendingcolon
withitssemilunar
folds.

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ArterialSupplyoftheColon
Thecolonissuppliedby
branchesofthesuperior
mesentericandinferior
mesentericarteries.
Superiormesenteric
artery
ileocolicartery
superiorbranch
thatjoinsthe
rightcolic
cecalbranch
appendicular
branch
ilealbranch
rightcolicartery
descending
branchtojoin
thesuperior
branchofthe
ileocolic
ascending
branchthat
joinstheright
branchofthe
middlecolic
middlecolicartery
rightbranch
leftbranchthat
joinswiththe
ascending
branchofthe
leftcolicartery
Inferiormesenteric
artery
leftcolic
ascending
branchthat
joinsthemiddle
colic
descending
branchthat
joinsthe
highestsigmoid
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branch
sigmoidarteries(2
3)
superiorsigmoid
branchjointhe
leftcolic
inferiorsigmoid
branchjoinsthe
superiorrectal
superiorrectalartery
notshowninthe
image

VenousDrainageofthe
GastrointestinalTract
Thevenousdrainageofthegastrointestinaltract,fromtheloweresophagustothe
upperrectumisbywayoftheportalvenoussystem.Thissystemalsodrainsthe
spleenandpancreas.
Theportalveinisusually
describedasbeingformed
bythesplenicand
superiormesentericveins.
Theinferiormesenteric
veinthenjoinsthesplenic
vein.However,thereare
variationstothispattern
andmightexist.Twoof
thesearethattheinferior
mesentericveinmayjoin
atthejunctionofthe
splenicwiththesuperior
mesentericortheinferior
mesentericveinsmayjoin
thesuperiormesenteric
veinbeforeitmergeswith
thesplenic.Identifythe:
superiorrectalvein
inferiormesenteric
vein
splenicvein
superiormesenteric
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vein
esophagealveins
leftgastricvein
portalvein

Thenumberedstars
representtheareaswhere
theportalvenoussystem
anastomoseswiththe
cavalvenoussystemand
areclinicallyimportantin
portalorcaval
hypertension.
1.esophagealplexus
cavaldrainageinto
azygosveins,portal
drainageintotheleft
gastricvein
2.rectalplexuscaval
drainageintomiddle
andinferiorrectal
veinsandtheninto
thepudendaland
internaliliacveins
backtoinferiorvena
cava,portaldrainage
intothesuperior
rectal,theinferior
mesentericandthe
splenic
3.paraumbilicalveins
cavaldrainage
downwardtothe
superficialinferior
epigastricveintothe
femoralvein,tothe
externaliliac,tothe
inferiorvenacava,
upwardtothe
thoracoepigastric
vein,thelateral
thoracicvein,
subclavianvein,
superiorvenacava,
portaldrainage
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throughthe
paraumbilicalveinto
theportalvein.

ClinicalConsideration
Portalobstruction.Incasesofliverdiseasewheretheportalbloodcannolonger
passthroughtheliver,thebloodwilltrytogetbacktotheheartanywayitcan
andthisusuallyinvolvesthesuperiororinferiorvenaecavae.Onepossiblecause
ofliverdiseaseischronicalcoholism.Whentheliverbecomesimpassable,itwill
passbackwardsthroughtheportalveinintotheleftgastric,paraumbilicalor
superiorrectal.Ateachofthesesites,theveinsbecomeenlargedandwillresultin
otherclinicalsignsandsymptoms.
Incaseoftheesophagealplexus(*1),esophagealvariceswilldevelopand
massivehemorrhagemayoccurresultingindeath.
Incaseoftherectalplexus(*2),hemorrhoidsoccur,resultinginpainand
bleeding.
Incaseoftheparaumbilicalveins(*3),visiblesignsofvenousenlargementand
tortuosityoccurontheabdomenandthesearereferredtothecaputmedusae.
Cavalblockage.Incaseswheretumorsorotherpathologiescompressthevena
cava,thebloodwillutilizetheaboveconnectionstoreturnbloodtotheheartbut
thistimethroughthecavalsystem.

JejunumandIleum

Liver

AbdominalCavity
stomach
Duodenum
IleumandJejunum
Liver
Pancreas
Spleen

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Thisiscopyrighted1999byWesleyNorman,PhD

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