§ Presentation Topic :

Large Intestine (Abdominal Part)

§ Presented by :
Muhammad Khizar Raza
§ Department :
Emergency and ICU Technology
§
§ Bashir Institute of Health Sciences,
Islamabad.
Large Intestine
 § Last part of GI Tract.
§ Extends from ‘Ileum to Anus’.
§ Abdominal parts are :
1. Cecum
2. Appendix

Introduction 3. Ascending Colon

4. Transverse Colon
5. Descending Colon
6. Upper Sigmoid Colon
 § Pelvic parts are :
1. Lower Sigmoid Colon

2. Rectum
3. Anal Canal

CONTI…. § Functions :
1. Absorption of water and electrolytes
2. Storage of Un-digested material
§
 § The cecum is that part of the large intestine that lies below the
level of the junction of the ileum with the large intestine.
§ It is a blind-ended pouch that is situated in the right iliac fossa.
It is about 2.5 in. (6 cm) long and is completely covered with

1. Cecum peritoneum. It possesses a considerable amount of mobility,

although it does not have a mesentery.
§ The presence of peritoneal folds in the vicinity of the cecum,
creates the superior ileocecal, the inferior ileocecal, and the
retrocecal recesses
 § Anteriorly : Coils of small intestine, sometimes part of the
greater omentum, and the anterior abdominal wall in the
right iliac region
§ Posteriorly : The psoas and the iliacus muscles, the femoral
Relations nerve, and the lateral cutaneous nerve of the thigh. The
appendix is commonly found behind the cecum.
§ Medially : The appendix arises from the cecum on its medial
side.
• Blood Supply :
Artery : Anterior and Posterior Cecal Artries

Vein : Superior Mesenteic Vein

• Lymph Drainage :
Superior Mesenteric Nodes
• Nerve Supply :
Superior Mesenteric Plexus
(Sympathetic and Parasympathetic nerves)
 § A rudimentary structure, the ileocecal valve consists of two
horizontal folds of mucous membrane that project around the
orifice of the ileum. The valve plays little or no part in the
prevention of reflux of cecal contents into the ileum. The
Ileocecal Valve circular muscle of the lower end of the ileum (called the
ileocecal sphincter by physiologists) serves as a sphincter
and controls the flow of contents from the ileum into the
colon.
 Diagram for
Ileocecal Valve
 § The appendix is a narrow, muscular tube containing a large
amount of lymphoid tissue. It varies in length from 3 to 5 in.
(8 to 13 cm). The base is attached to the posteromedial
surface of the cecum about 1 in. (2.5 cm) below the ileocecal
Vermiform junction.

Appendix § The appendix lies in the right iliac fossa, and in relation to the
anterior abdominal wall its base is situated one third of the
way up the line joining the right anterior superior iliac spine
to the umbilicus (McBurney’s point).
 § The tip of the appendix is subject to a considerable range of
movement and may be found in the following positions:

Common § (a) hanging down into the pelvis against the right pelvic wall.
§ (b) coiled up behind the cecum.
Positions of § (c) projecting upward along the lateral side of the cecum.
Appendix Tip § (d) in front of or behind the terminal part of the ileum.
§ The first and second positions are the most common sites.
§ Blood Supply :
Artery : Appendicular Artery
Vein : Appendicular Vein
§ Lymph Drainage :
Superior Mesenteric Nodes
§ Nerve Supply :
Superior Mesenteric Plexus
( Sympathetic and Parasympathetic Nerves)
 § The ascending colon is about 5 in. (13 cm) long and lies in the
right lower quadrant.
§ It extends upward from the cecum to the inferior surface of the
2. Ascending right lobe of the liver, where it turns to the left, forming the
right colic flexure, and becomes continuous with the
Colon transverse colon.
§ The peritoneum covers the front and the sides of the ascending
colon, binding it to the posterior abdominal wall.
 § Anteriorly : Coils of small intestine, the greater omentum, and
the anterior abdominal wall.
§ Posteriorly : The iliacus, the iliac crest, the quadratus
Relations lumborum, the origin of the transversus abdominis muscle,
and the lower pole of the right kidney. The iliohypogastric
and the ilioinguinal nerves cross behind it.
• Blood Supply :

Artery : Ileocolic and Right Colic branches of

Superior Mesenteric Artery.
Vein : Superior Mesenteric Vein
• Nerve Supply :
Superior Mesenteric Plexus
(Sympathetic and Parasympathetic nerves)
• Lymph Drainage :

Superior Mesenteric Nodes

 § The transverse colon is about 15 in. (38 cm) long and extends
across the abdomen, occupying the umbilical region.
§ It begins at the right colic flexure below the right lobe of the
3. Transverse liver and hangs downward, suspended by the transverse

Colon mesocolon from the pancreas. It then ascends to the left colic
flexure below the spleen. The left colic flexure is higher than
the right colic flexure and is suspended from the diaphragm
by the phrenicocolic ligament.
 § The transverse mesocolon, or mesentery of the transverse
Mesentry of colon, suspends the transverse colon from the anterior border

Transverse of the pancreas. The mesentery is attached to the superior

border of the transverse colon, and the posterior layers of the
Colon greater omentum are attached to the inferior border.
 § Anteriorly : The greater omentum and the anterior abdominal
wall (umbilical and hypogastric regions).
Relations § Posteriorly : The second part of the duodenum, the head of
the pancreas, and the coils of the jejunum and the ileum.
§ Blood Supply :
§ Artery : 1. Middle Colic Artery (proximal two thirds)
2. Left Colic Artery ( distal third )
§ Vein : Superior and Inferior Mesenteric Veins
§ Lymph Drainage :
1. Superior Mesenteric Nodes (proximal two thirds)
2. Inferior Mesenteric Nodes (distal third)
§ Nerve Supply:
1. Superior Mesenteric Plexus (proximal two thirds)
2. Inferior Mesenteric Plexus (distal third)
 § The descending colon is about 10 in. (25 cm) long and lies in
the left upper and lower quadrants. It extends downward
4. Descending from the left colic flexure, to the pelvic brim, where it
becomes continuous with the sigmoid colon. The peritoneum
Colon covers the front and the sides and binds it to the posterior
abdominal wall.
 § Anteriorly : Coils of small intestine, the greater omentum, and
the anterior abdominal wall.
§ Posteriorly : The lateral border of the left kidney, the origin of
the transversus abdominis muscle, the quadratus lumborum,
Relations the iliac crest, the iliacus, and the left psoas. The
iliohypogastric and the ilioinguinal nerves, the lateral
cutaneous nerve of the thigh, and the femoral nerve also lie
posteriorly.
§ Blood Supply :
Artery : Left Colic and Sigmoid braches of Inferior
Mesenteric Artery Vein : Inferior Mesenteric Vein
§ Lymph Drainage :
1. Colic Lymph Nodes
2. Inferior Mesenteric Nodes
§ Nerve Supply :
Pelvic Splanchnic Nerve
( Sympathetic and Parasympathetic nerves )
 § External Differences :
§ The small intestine (with the exception of the duodenum) is
Differences mobile, whereas the ascending and descending parts of the
colon are fixed.
between Small § The caliber of the full small intestine is smaller than that of
and Large the filled large intestine.

Intestine § The small intestine (with the exception of the duodenum) has a
mesentery that passes downward across the midline into the
right iliac fossa.
§ The longitudinal muscle of the small intestine forms a
continuous layer around the gut. In the large intestine (with
the exception of the appendix), the longitudinal muscle is
collected into three bands, the teniae coli.
§ The small intestine has no fatty tags attached to its wall. The
large intestine has fatty tags, called the appendices
epiploicae.
§ The wall of the small intestine is smooth, whereas that of the
large intestine is sacculated.
§ Internal Differences :
§ The mucous membrane of the small intestine has permanent
folds, called plicae circulares, which are absent in the large
intestine.
§ The mucous membrane of the small intestine has villi, which
are absent in the large intestine.
§ Aggregations of lymphoid tissue called Peyer’s patches are
found in the mucous membrane of the small intestine; these
are absent in the large intestine.