Large Intestine

Dr M Ressam Nazir

Large Intestine

Large Intestine
The large intestine is well suited to its main functions
1.Absorption of water and electrolytes 2.Formation of the fecal mass from undigestible material 3.Production of abundant mucus that lubricates the intestinal surface. 4.Intestinal bacteria also produce certain vitamins like Vit. K and B12

COLON and CECUM

The wall of the colon has the same basic layers as the small intestine.
1. 2. 3. 4. Mucosa (4,5,6,7) Submucosa (8) Muscularis Externa (13) Serosa/ Adventitia (3)

MUCOSA (Colon)
Lumen is larger than that of small intestine. Luminal surface of the mucosa is smooth. No villi or plicae circulares. In undistended colon, the mucosa and submucosa exhibit temporary folds. Epithelium
simple columnar with numerous goblet cells.

Intestinal glands Lamina propria

lymphatic nodules extending upto the submucosa

Muscularis mucosae

Epithelium Simple columnar epithelium Short irregular microvilli Goblet cells

Goblet cells are numerous. Increase in number towards terminal colon Mucous secreting cells (unicellular glands)

Submucosa
Connective tissue cells and fibers Blood vessels Nerves, Meissners plexus Lymphocytes and lymphatic nodules

Muscularis Externa (Colon)

Two layers of smooth muscle 1. Inner circular muscle layer
continuous in the colon wall

2. Taeniae coli
outer muscle layer condensed into three broad, longitudinal bands Contractions of taeniae coli produces haustrations in the wall of colon

 Myenteric (Auerbachs) nerve plexus

Parasympathetic ganglion cells Found between the two smooth muscle layers of the muscularis externa

Serosa (Colon)
Serosa
(visceral peritoneum and mesentery) covers the cecum, transverse colon and sigmoid colon. small, pendulous protuberances of adipose tissue (appendices epiploicae)

Colon- Identification points

Lumen is wider No villi Taenia coli present More numerous goblet cells

APPENDIX

Appendix

Appendix
It is a blind evagination of the cecum near the beginning of large intestine. Small and irregular lumen Very Irregular, very few and widely placed crypts Mucosa
Epithelium
Simple columnar Few Goblet cells

Lamina Propria
Intestinal glands (Crypts of Liberkhun) Shorter and less dense tubular glands Lymphatic nodules***
Numerous Germinal centers Extend upto submucosa

Muscularis mucosae- incomplete

 Submucosa
Numerous blood vessels

Muscularis Externa
Inner rcircular smooth muscles
Myenteric plexus

Outer longitudinal smooth muscles No taeniea coli**

Serosa- outermost coat

Appendix- Identification points

Ring of lymph nodules No taenia coli Fewer crypts Indistinct muscularis mucosae

MEDICAL APPLICATION
Appendix is a closed sac and its contents are relatively static, it can easily become a site of inflammation (appendicitis).
With the small lumen and relatively thin wall of the appendix, inflammation and the growth of lymphoid follicles in the wall can produce swelling that can lead to bursting of the appendix. Severe appendicitis is a medical emergency since a burst appendix will produce infection of the peritoneal cavity (peritonitis).

RECTUM

Rectum
Temporary longitudinal folds
(core of submucosa covered by mucosa)

Mucosa
Surface Epithelium
Simple columnar cells Striated border Goblet cells

Lamina Propria
Intestinal glands
longer, close together, filled with goblet cells

Adipose cells Lymphatic nodules

Muscularis mucosae

Rectum
Submucosa Muscularis Externa
Inner circular Myenteric plexus (parasympathetic ganglia) Outer longitudinal No taenia coli

Adventitia/ Serosa
Adventitia covers a portion of rectum, remaining is covered by serosa

Recto-anal junction

Recto-anal junction
Permanent longitudinal folds in lower rectum and anal canal >>>>> Anal columns of Morgagni Depressions between the anal columns >>>> Anal sinuses. About 2 cm above the anal opening, at the recto-anal junction, the lining of the mucosa is replaced by stratified squamous epithelium. In this region, the lamina propria contains a plexus of large veins that, when excessively dilated and varicose, can produce hemorrhoids.

Recto-anal junction (7) The Key Changes

1. 2. Muscularis mucosae and the intestinal glands terminate (3,4) Lamina propria is replaced by dense irregular connective tissue
(2,9)

3. 4.

5.

Submucosa merges with CT in the lamina propria of anal canal (5,9) Internal hemorrhoidal plexus of veins lie in the mucosa of anal canal (10) Muscularis Externa 1. Circular layer increases in thickness in upper region of anal canal and forms internal anal sphincter (6) 2. In lower part it is replaced by skeletal muscles of external anal sphincter (12)

The End