Large Intestine The large intestine begins in the RLQ, just lateral to the ileocecal valve.

The large
intestine consists of four major parts: cecum, colon, rectum, and anal canal (see Fig. 13-8). The
final segment of the large intestine is the rectum. The distal rectum contains the anal canal,
which ends at the anus. COLON VERS US LARGE INTESTINE Large intestine and colon are not
synonyms, although many technologists use these terms interchangeably. The colon consists of
four sections and two flexures and does not include the cecum and rectum. The four sections of
the colon are (1) the ascending colon, (2) the transverse colon, (3) the descending colon, and (4)
the sigmoid colon. The right (hepatic) and left (splenic) colic flexures also are included as part of
the colon. The transverse colon has a wide range of motion and normally loops down farther
than is shown on this drawing. CECUM At the proximal end of the large intestine is the cecum, a
large blind pouch located inferior to the level of the ileocecal valve. The vermiform appendix
(commonly referred to as just the appendix) is attached to the cecum. The internal appearance
of the cecum and terminal ileum is shown in Fig. 13-9. The most distal part of the small
intestine, the ileum, joins the cecum at the ileocecal valve. The ileocecal valve consists of two
lips that extend into the large bowel. The ileocecal valve acts as a sphincter to prevent the
contents of the ileum from passing too quickly into the cecum. A second function of the
ileocecal valve is to prevent reflux, or a backward flow of large intestine contents, into the
ileum. The ileocecal valve does only a fair job of preventing reflux because some barium can
almost always be refluxed into the terminal ileum when a barium enema is performed. The
cecum, the widest portion of the large intestine, is fairly free to move about in the RLQ.
Appendix The vermiform appendix (appendix) is a long (2 to 20 cm), narrow, worm-shaped tube
that extends from the cecum. The term vermiform means “wormlike.” The appendix usually is
attached to the posteromedial aspect of the cecum and commonly extends toward the pelvis.
However, it may pass posterior to the cecum. Because the appendix has a blind ending,
infectious agents may enter the appendix, which cannot empty itself. Also, obstruction of the
opening into the vermiform appendix caused by a small fecal mass may lead to narrowing of the
blood vessels that feed it. The result is an inflamed appendix, or appendicitis. Appendicitis may
require surgical removal, which is termed an appendectomy, before the diseased structure
ruptures, causing peritonitis. Acute appendicitis accounts for about 50% of all emergency
abdominal surgeries and is 1.5 times more common in men than in women. Occasionally, fecal
matter or barium sulfate from a gastrointestinal tract study may fill the appendix and remain
there indefinitely. LARGE INTESTINE—BARI UM-FILLED The radiograph shown in Fig. 13-10
demonstrates the barium-filled vermiform appendix; the four parts of the colon—ascending,
transverse, descending, and sigmoid; and the two flexures—the right colic (hepatic) flexure and
the left colic (splenic) flexure. The remaining three parts of the large intestine—cecum, rectum,
and anal canal—are also shown. As is shown by this radiograph, these various parts are not as
neatly arranged around the periphery of the abdomen as they are on drawings. There is a wide
range of structural locations and relative sizes for these various portions of the large intestine,
depending on the individual body habitus and contents of the intestine.