• • • •

vermiform [ L. vermis, wormlike] blind intestinal diverticlum 6 - 10 cm long arises from posteromedial aspect of cecum below ileocecal junction mesoappendix triangular mesentery

retrocecal most common

 pelvic  pre-ileal  sub-cecal  post-ileal

• • • •

Arterial supply - appendicular artery Venous drainage - appendicular vein Lymphatic drainage - ileocolic lymph nodes Nerve supply - superior mesenteric plexus - vagus nerve

Acute Appendicitis Symptoms: right lower quadrant pain McBurney’s point maximal pt of tenderness oblique line from R ASIS to umbilicus distal end of outer third approximates location of appendix approximates placement of incision

Mc Burney’s Point

PHYSICAL FINDINGS:
1. RLQ tenderness = visceral referred pain, T10 s.g. 2. Psoas sign = stretching of psoas by R thigh extension causes pain 3. Obturator sign = stretching of obt. internus by internal rotation causes pain

Cause:
I enlarged lymph node I fecalith

Treatment:
I Appendectomy

Incision : McBurney’s / Rocky-Davies Locate appendix: trace taenia coli towards posteromedial area of cecum w/c ends as appendix Ligate appendicular a/v = branch of ILEOCOLIC a/v

Complication:

PERFORATION
> at midportion [ least blood

supply ]
> spreads infection to parietal

peritoneum
> greater omentum adheres to

appendix to infection

restrict spread of

Consists of: • cecum • ascending colon • transverse colon • descending colon • sigmoid colon

Taenia coli  - 3 thickened band of muscle • Haustra - sacculations between taenia • Appendices - fatty projections of omentum • Internal diameter - larger

• • •

 • •

comprise longitudinal muscle of LI 3 taenia: 1] omental 2] free 3] mesocolic none in appendix - rectum begins at base of appendix ends at rectosigmoid junction

• • • • •

• •

1st part of LI continuous w/ ascending colon about 7.5 cm at right lower quadrant lies in iliac fossa inferior to terminal ileum palpable at abd wall if distended w/ gas or feces enveloped by peritoneum can be lifted freely

• • • •

has no mesentery attached to lateral abdominal wall by cecal folds receives the terminal ileum obliquely folds at ileocecal orifice form the ileocecal valve - 2 forms 1. Papillary - common 2. Labial folds meet laterally to form ridges frenulum

CECUM
1. Arterial supply - ileocolic art [ br of SMA] 2. Venous drainage - ileocolic vein 3. Lymphatic drainage - ileocolic lymph nodes Note: same for appendix & cecum 4. Nerve supply - sup. mesenteric plexus - vagus nerve

• -

circular muscle poorly developed around orifice not a true sphincter ICV does not control passage of intestinal contents from ileum into the cecum - ICV does not prevent reflux of intestinal contents from cecum back to ileum

4 parts forms an arch 1] Ascending 2] Transverse 3] Descending 4] Sigmoid

- passes superiorly on right side - turns to left below liver as R colic flexure or hepatic flexure
-

narrower than cecum

lies retroperitoneally on the R side of posterior abdominal wall covered by peritoneum anteriorly and on its sides

- 45 cm long - largest, most mobile - crosses abdomen from R colic flexure to L colic flexure - L colic flexure [splenic flexure]= more superior, more acute, less mobile compared to R, below spleen - transverse mesocolon [mesentery]= loops down to pelvis - variable in position

- from left colic flexure to

sigmoid - on left side - retroperitoneal - has a short mesentery - has a paracolic gutter on its side

- S shaped loop - 40 cm - connects desc colon and rectum - has long mesentery - thus, has considerable degree of freedom - termination of taenia coli = indicates rectosigmoid jxn - omental appendices = long

- root of sigmoid mesocolon = inverted V shaped attachment - various positions - twisting of root = cause obstruction -Structures near sigmoid > may be injured during surgery on sigmoid > commonly involved by diseases from sigmoid > structures: uterus [female] 1] Ur. Bladder [male] /

1. Arterial supply

Ileocolic art and R colic art [ br of SMA]
2. Venous drainage

Ileocolic v and R colic v [ trib of SMV]
3. Lymphatic drainage - Superior mesenteric LN 4. Nerve supply - Superior mesenteric nerve plexus

1. Arterial supply - Middle colic art [ fr SMA] - R and L colic art 2. Venous drainage - SMV 3. Lymphatic drainage - Sup. Mesenteric LN 4. Innervation - Sup mesenteric nerve plexus

1. Arterial supply - Left colic and sigmoid art [ br of IMA] 2. Venous drainage - Left colic and sigmoid vein [ trib of IMV] 3. Lymphatic drainage - Inferior mesenteric LN 4. Nerve supply = a.Sympathetic - Sup.hypogastric pl. b. Parasym = Pelvic splanchnic n.

1. Blood supply and venous drainage: R sided colon, appendix and transverse colon - SMA L sided colon and sigmoid colon - IMA 2. Ileocecal valve permits 2-way passage 3. 3 taenia coli : none in appendix and rectum 4. Lymph nodes grouping follow blood vessels 5. McBurney’s pt is very useful for clinicians

COLON CANCER - may involve any segment Diagnostic tests: 1] Barium enema = xray of colon 2] Colonoscopy = direct visualization 3] CT Scan with Oral and IV contrast

COLON CANCER Symptoms: 1] decreased size of stools 2] constipation 3] blood in stools Treatment: - colon containing the cancerous mass is resected including its arterial and venous drainage - lymph nodes dissected also

Ascending colon cancer = R hemicolectomy - ligate ileocolic, R colic and middle colic vessels Transverse colon cancer = Transverse colectomy - ligate middle colic, R and L colic vessels Descending colon cancer = L hemicolectomy - ligate left colic vessels Sigmoid colon cancer = Sigmoidectomy

- long mesentery - very mobile - can be visualized w/ sigmoidoscope - 25 cm from anus - common site of large intestinal obstruction as: 1] Volvulus twisting of mesosigmoid 2] Cancer - most common site 3] Diverticulitis- connects to UB form fistula

Familial Adenomatous Polyposis Coli

Familial Adenomatous Polyposis Coli

Carcinoma of the Colon (annular type)

Crohn’s Colitis

Perforated Diverticle

Tuberculosis

Pseudomembranous Colitis

Sign up to vote on this title
UsefulNot useful