Gross anatomy of the GI system – Notes (Part 2)

1. Large intestine : appendix, cecum, colon,

rectum
2. Accessory digestive organs: liver, gall
bladder, pancreas

Large intestine – Cecum & Appendix

Topography: right inguinal region
- Cecum: connection between the ileum (SI) and ascending colon
 Guarded by ileocecal valve: prevents reflux
 Is a pocket, acts as chyme storage location
 Completely intraperitoneal, no mesentery = completely mobile in right iliac
fossa

- Appendix vermiform: connects to medial aspect of cecum via ostium appendices

vermiformis
 Individual variation of positions: mostly retrocecal
 can be: anterior to cecum, lateral towards inguinal ligament, medial closer to
promontory of the pelvis
 lots of lymphoid tissue

anatomical landmarks:
- McBurney point: base of appendix
 1/3 of the distance laterally on a line drawn from
the umbilicus to the right anterior superior iliac
spine

- Lanz point: origin of the appendix

 line between the L R anterosuperior iliac spines, 1/3
of distance from right spine

Large intestines – Colon

- 4 parts: ascending, transverse, descending, sigmoid
Characteristic structure of the large intestine
- Semilunar folds: folds seen at the mucosal surface
 Abundant in colon, less in cecum, lack in rectum
- Haustra: pouches due to the semilunar folds
- Omental appendices: small pouches of peritoneum filled
with fat (yellow blobs)

- Taeniae coli: forms due to discontinuous nature of

longitudinal muscle in muscularis propria
 Tenia libera (free tenia): visible on anterior surface of
A&D colon
 Tenia omentalis: visible on anterior surface of
transverse colon
  Tenia mesocolica: between the above 2 taeniae, medially located
ALL absent in cecum and rectum

Ascending colon
- Topography: right lateral region; right colonic flexure at the right hypochondrial
region
- Retroperitoneal organ (secondary), continuation of cecum
- Reaches up to inferior surface of liver

Transverse colon
- Topography: from right hypochondriac region  umbilical region  left
hypochondrial region
- Ends at l. hypochondrial region (left colon flexure): higher than right counter part
- Transverse mesocolon: suspends transverse colon on posterior abdominal wall
- Longest, most mobile part of colon
Descending colon
- Topography: left lateral region, retroperitoneal organ (secondary)
- Between the left colic flexure and left iliac fossa (pelvis), continuous with sigmoid
colon

Sigmoid colon
- Sigmoid mesocolon
- Highly variable in length
- Anterior to the S3 segment
- Ends at rectosigmoid junction
 Haustra, teniae, omental appendices cease here

Accessory organ – Liver

- Topography: right upper quadrant
 Right hypochondrium & epigastric region & into left hypochondrium
- Superior boarder: 10th rib
- Lies deep to 7th – 11th ribs on the right, across
midline towards left nipples
- Surfaces : diaphragmatic surface, visceral surface
(close to duodenum, RK, colon pylorus)

Anterior: 2 lobes (Right > left size)

 Falciform ligament separates
Posterior: 4 lobes (right, left; quadrate (top), caudate
(bottom), separated by porta hepatis)

- Liver separated into segments – surgical

implications

- Bare area: on posterior, diaphragmatic surface

 not covered by fat/ ligaments/ peritoneum
  direct contact with diaphragm and IVC

ligaments of the liver (7 total)

a. anterior surface of liver
Falciform ligament: liver to anterior body wall
Coronary ligaments: continues with falciform
ligament, connects liver to diaphragm
Triangular ligament: the actual ‘corners’

b. liver to surrounding organs

hepatogastric ligament: liver to stomach
hepatoduodenal ligament: contains the common bile duct, hepatic portal vein and
hepatic artery. Protects the porta hepatis
hepatorenal ligament: liver to kidney
round ligament: extends to anterior surface at the bottom, extends to the umbilicus

Accessory organ – Pancreas

- Topography: epigastric region & left hypochondriac region
- Retroperitoneal organ (secondary)
- Exocrine and endocrine component
- 3 parts
 Head: at the level of T2, encompassed by duodenum
 Body: goes across vertebrae column
 Tail: reaches the spleen
- Pancreatic duct: drains pancreatic secretion
- Accessory pancreatic duct: into minor papilla
- Common bile duct + pancreatic duct = ampulla of vater, empties into duodenum via
major papilla
- Sphincter of oddi: smooth muscle, controls secretion entry into major papilla
- Dual blood supply: celiac trunk & superior mesenteric trunk

Accessory organ – Gall Bladder

- 3 parts: fundus (rounded end), body, neck
- Gall stones formation: mostly pigment (HK)/ cholesterol stone
- Cholecystectomy: definitive treatment for gallstone (recurrence), prevent future
pancreatitis

Gallstones in  Clinical Presentation 

Gallbladder   Asymptomatic
 50-70% at time of diagnosis 
 Symptomatic when >8 mm 
  Uncomplicated
 Complicated

Cystic duct  Cholecystitis

 Acute - RUQ pain 
 Chronic 
 Gallbladder Mucocele
 Empyema: mucocele infection

Intrahepatic bile  Cholangitis

duct  Infection with pain, fever 

Common bile duct  Jaundice 

 Cholangitis
 Pancreatitis

Accessory system – Biliary system flow

- Involves liver, gall bladder
- Hepatocytes produce bile for fat emulsification
 Bile canaliculi  Intrahepatic bile ducts 
left and right hepatic duct  common
hepatic duct
- Gall bladder: stores and concentrates bile
between meals
- Common bile duct = common hepatic duct +
cystic duct
- CBD + Pancreatic duct = ampulla of vater