You are on page 1of 4

Abdominal region : i) transpyloric plane L1 ii) subcostal plane L3 iii) intertrochanteric plane L5 iv) Rt & Lt midclavicular lines Small intestine - longest part

of GIT extend from pyloris to ileocecal j(x) - situated in the epigastric and umbilical regions - into three parts: the duodenum, the jejunum, and the ileum Duodenum - C shaped tube - 25cm long - Receive opening of bile & pancreatic ducts - Curve around d head of pancreas - retriperinocal w exception of 2.5cm - mucus membrane in 1st part - others contain circular fold (plicae circularis) Part of duodenum Explanation 1st part -begins at pyloris,run upward n backward on transpyloric plane L1 -5cm long -gastroduodenal arteries lies posterior to it -ulser easy to spread 2nd part -about 7.5cm -runs vertically downward -bile duct n main pancreatic pierce duodenal wall about ½ way down of Its medial border ( junction of foregut n midgut) -both ducts unite to form ampulla that opens on summit of major duodenal papilla (guarded by spinchter of Oddi) -accessory pancreatic duct (duct of santorini) open into minor duodenal papilla 3rd part -about 10cm -runs horizontally to d left on subcostal plane 4th part -about 2.5cm -runs up to n d left to d dudenojejunal flexure in position n attached to right crus of diaphragm Arteries supply - upper ½ by sup. pancreaticoduodenal artery (gastroduodenal artery) - lower ½ by inf. pancreaticoduodenal artery (branch of sup.mes.artery) Venous drainage -Upper ½ by sup. Pancreaticoduodenal vein - portal vein -lower ½ by inf. Pancreaticoduodenal vein - sup.mes vein Lymph drainage -Upper ½ - celiac nodes Nerve supply - sympathetic & parasympathetic (vagus nerve) thru celiac & sup.mes plexus

-lower ½ - sup.mes nodes

Jejunum & Ileum - about 3ft (6m) long - jejunum begins at duodenojejunal flexure - ileum ends at ileocecal j(x) - coils of both r freely mobile & attached to post. abdomen wall by mesentery - peritoneal fluid inside of peritoneal cavity

Jejunum -coiled at upper part of peritoneal cavity -wider,thicker,redder -more plicae circularis -jejunum mesentery attach above & to left of aorta -less fat deposit -less arcades -no Peyer’s patches Arteries supply - through jejunum & ileacecal artery from sup.mes artery - arteries reach intestine thru mesentry - lower part of ileum supplied by ileocolic artery Venous drainage - correspond to arteries & drain to sup.mes vein

Ileum -coiled at lower part of peritoneal cavity & at pelvic cavity -smaller, widely separated -less plicae circularis -jejunum mesentry attach below & to right of aorta -more fat deposit -more arcades Peyer’s patches presence Lymph drainage - pass thru many mesenteric nodes & reach sup.mes nodes around origin of sup.mes artery at L1 Nerve supply -sympathetic & parasympathetic (vagus nerve) from sup.mes plexus

Large Intestine - extend from ileocecal j(x) to anus - 1.5m in length - consists of : ~ cecum ~ ascending colon ~ appendix ~ descending colon ~ rectum ~ tranverse colon

~ sigmoid

Cecum - blind ended pouch in d Rt iliac fossa, below level of iliocecal j(x) - about 6cm - covered w peritoneum - mobile but not mesentery - longitudinal muscle – restricted to 3 flat bands (Taniae coli that converge on d base of appendix ) - distended w gas - ileocecal valve is provided w 2 folds (no role in preventing reflux) - appendix communicate w cecum thru opening above & below ileocecal opening Arteries supply - ant. & post. cecal artery from ileocolic artery (branch of sup.mes artery) Venous drainage - correspond to arteries & drain to sup.mes vein Lymph drainage - thru several mes. nodes & reach sup.mes lymph nodes Nerve supply - sympathetic & parasympathetic (vagus) nerves form the sup.mes. plexus

Appendix - narrow,muscular tissue contain lymph tissue (defense mech.) - variable in length - base attached to post. medial surface of cecum about 2.5cm below iliocecal j(x) - mobile or free w no base - no base - has mesoappendix which contain vessel & nerves - base is at 1/3 of way up line joining Rt. ASIS to ambilicus (Mc Burney’s point) - complete peritoneal covering Arteries supply - appendicular artery is branch of post.cecal artery from ileocolic artery Venous drainage - appendicular vein drains into post. cecal vein Lymph drainage - drain into one or two nodes lying in the mesoappendix & then eventually into the sup.mes nodes Nerve supply - sympathetic & parasympathetic (vagus) nerves form the sup.mes. plexus

Ascending colon - from cecum to Rt colic flexure(hepatic flexure) - continuous with the transverse colon. - about 13cm - lies in the right lower quadrant - covered ant. by peritoneum Arteries supply - thru ileocolic & right colic branches of the superior mesenteric artery Venous drainage - correspond to the arteries &drain into the sup. mes vein Lymph drainage - drain into lymph nodes lying along d course of d colic blood vessels & ultimately reach sup. mes nodes Nerve supply - sympathetic & parasympathetic (vagus) nerves form the sup.mes. plexus

Transverse colon - about 38cm - has mesentery (transverse mesocolon) - occupy umbilical region - left colic flexure is higher than right colic flexure - from hepatic flexure to splenic flexure - ascends to left colic flexure below the spleen - suspended from diaphragm by phrenicocolic ligament Arteries supply - proximal 2/3 r supplied by middle colic artery,a branch of the sup. mes artery - distal third is supplied by left colic artery,a branch of inf. mes artery Venous drainage - correspond to arteries & drain into superior & inf. mes veins Lymph drainage - proximal 2/3 drain into colic nodes & then into sup. mes nodes - distal third drains into colic nodes & then into inf. mes nodes. Nerve supply - proximal 2/3 r innervated by sympathetic & vagal nerves thru sup. mes plexus - distal third is innervated by sympathetic & parasympathetic pelvic splanchnic nerves thru inf. mes plexus.

Descending colon - about 25cm - extent from Lt colic flexure to pelvic brim, where it becomes continuous w sigmoid colon - peritoneum covers front & sides & binds it to post.abdominal wall

Arteries supply - left colic & sigmoid branches of the inf. mes artery

Venous drainage - correspond to arteries & drain into the inf. mes vein

Lymph drainage - drains into colic lymph nodes & inf. mes nodes around origin of inf. mes artery

Nerve supply - sympathetic & parasympathetic pelvic splanchnic nerves thru inf. mes plexus

Sigmoid colon - 25-40cm -continuation of descending colon in front of pelvic brim (entrance) - continous w rectum (3rd sacral vertebrae) - mobile - has sigmoid mesocolon (volvolus) Differences Between the Small and Large Intestine Small intestine -small lumen -middle of abdomen -no teniae coli -no portal circulation -mobile except duodenum -has a mesentery that passes downward across midline into right iliac fossa -small intestine has no fatty tags attached to its wall -wall of the small intestine is smooth -mucous membrane has permanent folds, called plicae circulares -mucous membrane has villi Large intestine -large lumen -peripheral abdomen -has teniae coli -has portal circulation -ascending & descending parts of colon r fixed -absence of mesentery -has fatty tags, called the appendices epiploicae -large intestine is sacculated -absence of plicae circulares -absence of villi