Small & Large Intestine

Gastrointestinal block-Anatomy-Lecture 6,7

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 Objectives Color guide :
Only in boys slides in Green
Only in girls slides in Purple
important in Red
At the end of the lecture, students should be able to: Notes in Grey
● List the different parts of small intestine.
● Describe the anatomy of duodenum, jejunum & ileum regarding:
(the shape, length, site of beginning & termination, peritoneal
covering, arterial supply & lymphatic drainage)
● Differentiate between each part of duodenum regarding the
length, level & relations.
● Differentiate between the jejunum & ileum regarding the
characteristic anatomical features of each of them.
● List the different parts of large intestine.
● List the characteristic features of colon.
● Describe the anatomy of different parts of large
intestine regarding:
(the surface anatomy, peritoneal covering, relations, arterial &
nerve supply)
Small intestine
The small intestine divided into :

Fixed Part (No Mesentery): Free (Movable) Part (With

Parts Duodenum* Mesentery): Jejunum &
Ileum

Shape C-shaped loop coiled tube

Length 10 inches 6 meters (20 feet)

Transverse Colon separates the
Beginning At pyloro-duodenal junction at duodeno-jejunal flexure stomach/liver from the
jejunum/ileum

Termination At duodeno-jejunal flexure at ileo-ceacal flexure

Peritoneal Covering Retroperitoneal mesentery of small intestine

Divisions 4 parts ---------

Foregut (above bile duct opening in 2nd part )& Midgut

Embryological origin Midgut (below bile duct opening in 2nd part)
So 2nd part has double origin and double supply

Coeliac (artery of foregut) Superior mesenteric

Arterial Supply Superior Mesenteric (artery of midgut)

Lymphatic Drainage Coeliac & Superior Mesenteric Superior mesenteric

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* 1st inch of 1st part has an omentum with the stomach
 Duodenum parts
1st Part 2nd Part 3rd Part 4th Part
Part
( Superior ) (Descending) (Horizontal) (Ascending)

Length 2 inches 3 inches 4 inches 1 inch

Ascends from L3
Level L1 (Transpyloric Plane) Descends from L1 to L3 L3 (Subcostal Plane)
to L2 1

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2

1) Liver
Anterior 1) Small intestine
Liver 2) Transverse Colon Small intestine
Relations 3) Small Intestine
2) Superior mesenteric vessels 3

1) Bile duct 1) Right psoas major

Posterior 2) Gastroduodenal artery* 2) Inferior vena cava
Right Kidney Left psoas major
Relations 3) Portal Vein 3) Abdominal aorta
4) Neck of pancreas 4) Inferior mesenteric vessels

Medial
- head of Pancreas - -
Relations

Lateral
- Right Colic Flexure - -
Relations

● Opening of accessory pancreatic duct One inch higher), on summit of minor duodenal papilla
Openings of the 2nd
● Common opening of bile duct & main pancreatic duct On summit of major duodenal papilla (vater)
part the bile duct could be obstructed in case of head of pancreas carcinoma
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*if there is an ulcer in the duodenum, Gastroduodenal artery will be the source of bleeding
Comparison Between Jejunum & Ileum
Jejunum Ileum

Length Shorter (Proximal 2/5) Longer (Distal 3/5)

Diameter Wider Narrower

Wall Thicker (More Plicae Circulares) Thinner (Less Plica Circulares)

Appearance Dark Red (More Vascular) Light Red (Less Vascular)

The absorption happen in Jejunum more, so it need to be
Vessels Less Arcades (Long Terminal More Arcades (Short Terminal wider and thicker to increase the surface area of
Branches) Branches) absorption, also it need to be more vascular to facilitate
moving of substance to the circulation
Mesenteric Small Amount away from Large Amount Near Intestinal
Intestinal Border Border While Ileum is longer and thinner, so it need more fat in
Fat around to support it and this fat need supply, so it will be
hard for the blood to reach the illem so the vessels need
Lymphoid Few Aggregations Numerous Aggregations to be More Arcades to penetrate the fat and supply it. As
Tissue (Peyer’s Patches) result of that the blood that reach the ileum will be less so
its less vascular

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 Large Intestine

Parts of Large Intestine Characteristics of COLON Peritoneal covering

In Abdomen Taeniae coli Parts With Mesentery

- cecum (in right iliac region ) 3 longitudinal muscle bands 1. Transverse colon (transverse mesocolon)
- appendix (in right iliac region ) 2. Sigmoid colon (sigmoid mesocolon)
- Ascending Colon (in right lumbar region ) Sacculations (Haustra) 3. Appendix (mesoappendix)
- Transverse Colon (in 4,5,6 regions ) Because the Taeniae coli are shorter 4. Cecum (could be without) (see slide 8)
- descending Colon (in left lumbar, iliac regions ) than large intestine Retroperitoneal Parts
In pelvis Epiploic Appendices 1. Ascending colon
-sigmoid Colon (in left iliac, hypogastric regions ) 2. Descending colon
Short peritoneal folds filled with fat 3. Upper ⅔ of rectum
-rectum (in right iliac region )
NOTE:THESE CHARACTERISTICS ARE NOT Parts Devoid Of
In peritoneum FOUND IN RECTUM & ANAL CANAL Peritoneal Covering
1. Lower ⅓ of rectum
-anal Canal 2. Anal canal

Rectum

Anal
canal
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 1 Cecum–ascending & Descending Colons
Parts Cecum Ascending colon Descending colon
1
Anterior Relations
Coils of small
1-Greater omentum 2-Coils of small intestine 3-Anterior abdominal wall intestine

1. Right Psoas 1. Right Iliacus 1. Left Iliacus

major 2. Right Quadratus 2. Left Quadratus lumborum
2. Right Iliacus lumborum 3. Left kidney. Quadratus
kidney
Nerves: (all right)* 3. Right kidney. 4. Left Psoas major lumborum
Posterior Relations Iliohypogastric Nerves: (all right)* Nerves: (all left)*
Ilioinguinal lateral cutaneous of thigh Iliohypogastric ,Ilioinguinal, lateral Iliacus
Psoas
major
,Femoral,Genitofemoral cutaneous of thigh Femoral,
Genitofemoral;

2 Transverse Colon

Anterior

Superior
Anterior Relations Posterior Relations Superior Relation Inferior Relation

1-greater omentum 1-2nd part of duodenum 1-liver 1-coils of small intestine

2-anterior abdominal wall 2-pancreas 2-gallbladder
3-superior mesenteric 3-stomach
vessels

Posterior
Inferior
3 Colic Flexures
❖ Hepatic flexure (right colic flexure): position: lower(liver push it down) + angle: wider
❖ Splenic flexure (left colic flexure): Position: higher + Angle: more acute
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*from the picture in the lecture

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Appendix 5 Rectum
● the base of appendix is marked Beginning
by Mc’Burney’s point:
Surface ● A point at the junction of
as a continuation of sigmoid colon at level of S3
anatomy lateral ⅓ & medial ⅔ of a line
● traced from right anterior
superior iliac spine to umbilicus Termination
At posteromedial aspectof cecum, 1 inch below continues as anal canal, one inch below & in front of tip of coccyx.
Opening ileo-cecal junction Its end is dilated to form the rectal ampulla.

1.Retrocecal:(most common)
2.Pelvic
Length
3.Subcecal
13 cm(5 inches)
Positions 4.Preilieal
5.Postileal:(least common)
if the appendix in any position rather than (1) the cecum Relations of Rectum in Pelvis
will be without mesentery Vs.
Males Females
Anterior : Anterior :
1.Posterior surfaces of urinary 1.posterior wall of vagina
bladder
2.Seminal vesicles
3.Prostate gland

Rectum Relations of Rectum in Pelvis Posterior: 1.Sacral plexus 2.Sacrum 3.Coccyx

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Relation between embryological origin of GIT & Supply
Arterial Supply

1-Foregut: 2-Midgut (endoderm) : 3-Hindgut (endoderm): 4-Ectoderm:

celiac trunk Superior mesenteric artery Inferior mesenteric artery inferior rectal artery
Includes Stomach ,liver, Includes the Rest of Left ⅓ of transverse colon, Lower part of anal canal
gallbladder, pancreas, spleen, duodenum ,jejunum, ileum, descending colon, sigmoid
upper part of duodenum until cecum,appendix, ascending colon, rectum, upper part of
major duodenal ampulla colon, right ⅔ of transverse anal canal
colon

Venous Drainage Lymph drainage of GIT Nerve Supply

● Veins draining gut form the portal
circulation ● The lymph vessels follow the arteries. ● Midgut (endoderm) : Autonomic nerve
● All veins finally end into portal vein ● Ultimately, all the lymph is collected at supply :Sympathetic + Vagus nerve
the Preaortic lymph nodes (Superior &
which enters the liver ●
Inferior mesenteric). ● Hindgut (endoderm) Autonomic nerve
supply :Sympathetic + pelvic
splanchnic nerves (S2,S3,S4)
●
● ectoderm(lower ⅓ of anal canal)
Somatic nerve supply :inferior rectal
(branch of pudendal nerve)
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 Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8

QUIZ 1 D C C B A B D B

Q1: The duodenum originates from the ……. Q5: What part of the duodenum lies in the transpyloric plane?
A. Foregut A. 1st
B. Midgut B. 2nd
C. Hindgut C. 3rd
D. A&B D. 4th
Q2: Which of the following could be injured in case of perforated duodenal ulcer? Q6: the length of the Jejunum & Ileum is
A. Right kidney A. 6 inches
B. Right colic flexure B. 6 meter
C. Gastroduodenal artery C. 10 meter
D. Inferior mesenteric vessels D. 10 inches
Q3: if there is a stone in gallbladder ,Which part of intestine initially receives the stone? Q7: :Which one of these contains numerous aggregation of Lymphoid Tissue ?
A. cecum A. Jejunum
B. ascending colon B. Stomach
C. 2nd part of duodenum C. duodenum
D. 3rd part of duodenum D. ileum
Q4: Which of the following lies anterior to the third part of duodenum? Q8: Which ONE of the following lies behind the 3rd part of the duodenum?
A. Right psoas major A. inferior mesenteric vein
B. Small Intestine B. inferior mesenteric artery
C. Ureter C. superior mesenteric artery
D. Bile duct D. Gastroduodenal artery
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 Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8

QUIZ 2 B C A C C B A D

Q1: where does the rectum begin? Q5: One of the superior relations to transverse colon is

A. At s3 as continuation of cecum A. Coils of small intestine

B. At s3 as continuation of sigmoid colon B. Anterior abdominal wall

C. At L3 as continuation of cecum C. Gallbladder

D. At L3 as continuation of sigmoid colon D. Right kidney

Q2: which one of the following structures found in pelvis? Q6: if superior mesenteric artery and vagus nerve injured. Which part of colon will be affected?

A. Anal canal A. Ascending and descending

B. Descending colon B. Ascending and transverse

C.sigmoid colon C. Descending and sigmoid

D.appendix D. Descending and transverse

Q3: which one of the following structures marked by Mc’Burney’s point? Q7: Appendix opens at posteromedial aspect of cecum, ……below ileocecal junction
A. Base of appendix A. 1 inch
B. Apex of appendix B. 5 inches
C. Beginning of cecum C. 3 inches
D. Termination of cecum D. 2 inches
Q4: the innervation of inferior part of anal canal is : Q8: One of anterior relations of rectum in males is
A. Autonomic,by vagus nerve A. Vagina
B. Somatic, by pudendal nerve B. Sacral plexus
C. Somatic ,by inferior rectal nerve C. Sacrum
D. Autonomic, by pelvic splanchnic nerve D. Posterior surfaces of urinary bladder
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