Block Gastro 2012 Lower & Accesory GI Tract

COLON

POSITION OF GI TRACT

POSITION OF COLON

DIVISION OF COLON

80 cm•Cecum•Colon ascendens•Colon transversum•Colon descendens•Colon sigmoideum•Rectum•Canalis analis

COLON ASCENDENS80 cmCecum – the first part of the large intestineTaeniae coli – three bands of smooth muscle Haustra – bulges caused by contraction of taeniae coli Epiploic appendages – small fat accumulations on the viscera

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Location: right lumbar hypochondriaca

Length 8 inches (15-20 cm)

Right colic flexure colon transversum

Secondarily peritoneal Taenia, Haustra, Plicae

semilunares Epiploic appendages

Ascending colon

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Hepatic flexure : ren dex, duod inf

Splenic flexure : ren sin, spleenLength 45 – 50cm Intraperitoneal Supported by transverse mesocolon and gastrocolic lig

Colon transversum

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Location : left lumbar Begin at splenic flexureLength : 25 cmDiameter smaller than ascending colon

Secondarily peritoneal

Colon descendens

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Location: pelvic Length : 25-40 cm Related to urinary bladder (male), uterus and vagina (female)

Continues to rectum at 3rd sacral level

Peritoneal Function: storage of feces

Colon Sigmoid

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Rectum ◦Retroperitoneal

Anal canal◦Retroperitoneal◦Inferior to pelvic diaphragm◦Anal triangle of perineum

Rectum and Anal canal

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Internal sphincter : ◦ circular muscular

layer under involuntary control.

External sphincter : ◦ striated muscle

under voluntary control.

Anal sphinchter

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Internal structure

o Anal columns

o Anal valves

o Pectinate line

o Anal verge

o Anal glands

o Anal sphincter

internal

o Anal sphincter

external

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◦A. mesenterica superior: jejenum, ileum, cecum, appendix

◦A. mesenterica inferior: colon, sigmoid, rectum

Blood supply of colon

A. rectalis sup a. mesenterica inf A. rectalis med a. iliaca interna A. rectalis inf a. pudenda interna

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A. colica sinistra Aa. sigmoidea A. rectalis superior A. rectosigmoidea A. marginalis

A. Mesenterica superior

A. pancreaticoduodenalis inferior

A. jejunalis A. ilealis A. colica media A. colica dextra A. ileocolica A. marginalis

A. Mesenterica inferior

Superior mesenteric ileocolic aright colic amiddle colic a

Inferior mesenteric left colic asigmoid arteries superior rectal a

ARTERY OF COLON

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Blood supply A. rectalis inferior A. rectalis media A. rectalis superior

Venous return◦v. rectalis inferior◦v. rectalis media ◦v. rectalis

superior

Vasculature

Simpatis

Lesser splanchnic nn

Parasimpatis

Plexus sacralis S2– S4

HEPAR,VESICA FELLEA, PANCREAS

POSITION OF THE LIVER

Located at right hypochondriaca epigastrica region Palpable: costal margin, lateral to rectus abdominis

STRUCTURE OF LIVER

Blood Supply to the Liver

Hepatic Artery Hepatic Portal

Vein Hepatic Vein

Length 6-10 cm Capacity 45 ml Lies within fossa

vesica fellea Divided into 3

parts: fundus, body and neck

VESICA FELLEA

Function of Pancreas

Endocrine Alpha cells: Glucagon Beta Cells: Insulin Delta Cells: Somatostatin

Exocrine gland 1 - 1.5l pancreatic juice / day Enzymatic component - digestive enzymes

(1) Proteases,(2) Lipolytic ,(3) Amylase

POSITION OF PANCREAS

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epigastricleft hypochondriaca

Head , Body, Tail Pancreatic ducts:

◦ Primary pancreatic duct duodenal papilla

◦ Accessory pancreatic accessory duodenal papilla about 2 cm above the primary duct

Structure of Pancreas

BLOOD SUPPLY OF PANCREAS

POSITION OF LIEN

The spleen is approximately 11 cm in length. weighs between 150 -200 gr, lies in front of the 9th to the 12th thoracic ribs.

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Spleen Lies in the left hypochondriaca adjacent to stomach, from ribs 9, 10,11,12

Supported by gastrosplenic and splenorenal ligs.

Composed of lymphoid tissue

Supplied by A. lienalis

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Blood supply of lien