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Large Intestine

Large Intestine. Dr. Anna L. Kiss. Department of Anatomy, Histology and Embryology Semmelweis University Budapest 2018. Left colic flexure. Right colic flexure. Large intestine. descending colon. Transverse colon. ascending colon. sigmoid colon. Coecum. Rectum. Appendix vermiformis.

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Large Intestine

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  1. LargeIntestine Dr. Anna L. Kiss Department of Anatomy, Histology and Embryology Semmelweis University Budapest 2018

  2. Left colic flexure Right colic flexure Large intestine descending colon Transverse colon ascending colon sigmoid colon Coecum Rectum Appendix vermiformis Canalis analis

  3. Tenia omentalis Haustra Plica semilunaris Tenia mesocolica Tenia libera Appendices epiploicae Mesoappendix Vastagbél left colic flexure right colic flexure descending colon transverse colon ascending colon Sigmoid colon Coecum Rectum Appendix vermiformis Canalis analis

  4. Teniae mesocolon transversum Tenia mesocolica (hidden) plica semilunaris Tela muscularis haustrum Tenia libera (visible) Tenia omentalis (hidden) Appendix epiploica graeter omentum

  5. Large Intestine from the outside and from the Inside

  6. Chracterisitcs of the large intestine Plicae semilunares: tela muscularis, stratum circulare (inside) Teniae coli: tela muscularis, stratum longitudinale (outside) Haustra: outpouches between teniae and plicae semicirculares Appendices epiploicae (omentales): fatty pouches in the subserose layer

  7. left colic flexure right colic flexure descending colon ascending colon tansvese colon caecum sigmoid colon ileum appendix symphysis rectum

  8. A. mesenterica superior A. mesenterica sup. Middle colic a. Riolani arch right colic a. Arteriae jejunales Ileocolica a. coecal a. Arteriae ilei

  9. A. mesenterica inferior Abdominal aorta Riolani arch left colic a. middle colic a. Inf. mesenteric a. A Sudeck’s point Aa. sigmoidales B sup. rectal a. A: not dangerous B: risk

  10. Recesses of the coecum sup. Ileocoecal recess ascendening colon Ileocolic a. Plica semilunaris Ileum terminale Inf. ileocoecal recess A. coecalis ant. A. coecalis post. Mesoappendix appendicular a. Tenia libera Tenia mesocolica Appendix epiploica Appendix vermiformis Coecum Tenia omentalis

  11. Recesses of the coecum Sup. ileocoecal recess Recessus intersigmoideus Inf. Ileocoecal recess

  12. Ileocoecal transition Tunica muscularis et serosa Root of the mesentery Mesentery Plica semilunaris Ileocoecal valve (Bauhin-valve) Ileum terminale Frenulum Mesoappendix Ostium appendicularis Appendix vermiformis

  13. Tipical pressure points in case of appendicitis

  14. Position of the appendix Spina-umbilicus line (1) Retrocoecal position (e) anteroparietal position (b) McBurney’s point (2) Lumbal position (d) Interspinal line (5) ant. sup. iliac spine (4) Lanz’s point (3) Ilioinguinal position (c) Lig. inguinale (6) Pelvic position (a)

  15. Positions of the appendix Positio lumbalis (d) Positio anteroparietalis (b) Positio retrocoecealis (d) Positio ilioinguinalis (c) Positio pelvina (a)

  16. Large Intestinal Mucosa Histologic Characteristics of Large Intestines as Compared to Small Intestines • lack of villi • deeper crypts • rich in goblet cells • absence of Paneth-cells • adipose tissue in • submucosa and subserosa • only single lymph nodes (solitary lymphatic follicles)

  17. Wall of Large Intestines Epithelium of mucosa Tunica muscularis of mucosa Lamina propria (+ Lieberkühn’s crypts) Tela submucosa Tunica muscularis + serosa Tenia coli

  18. Histology of the wall of the large intestine Epithelium mucosae Lamina propria mucosae (+ Lieberkühn’s crypts Tela submucosa Tunica muscularis mucosae

  19. Wall of Large Intestines Mitotic cells (M) Muscularis mucosae Lamina propria mucosae Goblet cells

  20. Appendix Vermiformis human vermiform process

  21. Appendix vermiformis Folliculi lymphatici Tela submucosa Tunica mucosa Tunica muscularis + Serosa Lieberkühn’s crypts

  22. Rectum L3 Discus intervertebralis L5 Colon sigmoideum S3 Sacral flexure Ampulla recti Perineal flexure

  23. Anatomical border Rectum (Ampulla recti) Ampulla recti Anorectal line (3-4,5 cm) Canalis analis Canalis analis + Anus Canalis analis Anus

  24. Canalis analis, anal canal Colorecatal zone: above the anorectal junction: similar to rectum (simple columnar epithelium) Transitional zone: upper part: anal columns, columns of Morgani lower part or squamous part: no columns of Morgani

  25. Canalis analis Lower part of the rectum: anal canal 1.) zona columnaris: : columna anales:anal columns (longitudinal folds) mucosal folds, columns of Morgani: stratified non-keratinized squamous epithelium sinus anales, Morgagni-sinuses: epithelium: simple columnar 2.) zona intermedia (haemorrhoidea), squamous part: no Morgagni-sinuses epithelium: stratified non-keratinized squamous connective tissue: sebaceous glands no hair follicles+ internal haemorrhoidal plexus sphincter ani internus: smooth muscle 3.) zona cutanea: skin circumanal glands: apokrine modified sweet glands

  26. Canalis analis linea dentata (pectinea)

  27. Histological and embryological border Endoderm (Mucosa recti) Ampulla recti Endoderma (Zona columnaris) Pecten analis Canalis analis Linea dentata, pectinea, mucocutanea (2 cm) Ectoderma (Zona haemorrhoidalis) Canalis analis Linea anocutanea (1 cm) Anus Ectoderma (Zona cutanea)

  28. laevator ani

  29. Canalis analis

  30. Peritoneal relationship of the rectum Vesicorectal pouch Rectouterine pouch

  31. Blood supply and venous drainaige of the rectum • sup. rectal art. (unpaired): inf.mesentric art. • middlerectal a. (paired): directlyfromtheint.iliac art. • inf. rectalis art. (paired): int.pudendal art. (int. Iliac art.) • sup. rectalvein (v. portae) • middlerectalvv (v. cavainf.) • inf. Rectal v. (int. Pudendal v. ; v. cavainf.)

  32. Blood supply of the rectum A. rectalis sup. (A. mesenterica inf.) Plica transversalis recti sup. A. rectalis media (A. iliaca int.) V. rectalissup. V. rectalis media M. obturator int. M. levator ani V. pudenda int. A. pudenda int. A. rectalis inf. (A. pudenda int.) V. rectalis inf. Plexus venosus rectalis int. M. sphincter ani ext. Canalis analis Plexus venosus rectalis ext.

  33. Venae hepaticae Venous dranaige of the rectum Máj Inf. vena cava inf. mesenteric vein sup. rectal vein (unpaired; NO valves!) int. Iliac vein Middle rectal vein (paired; valves!) M. levator ani int. pudendal vein inf. rectal vein (paired; valves!)

  34. Colon: simple cylindrical epithelium Anorectal Junction Transition: stratified columnar (cuboidal) epithelium Skin: stratified squamous keratinized epithelium Sphincter ani internus Lymphatic follicles

  35. References Bruce M. Carlson (2004). Human Embryology and Developmental Biology, 3rd edition, Saint Louis: Mosby. Richard Coico, Geoffrey Sunshine, Eli Benjamini (2003). Immunology: a short course. New York: Wiley-Liss.   Abraham L. Kierszenbaum (2002). Histology and cell biology: an introduction to pathology. St. Louis: Mosby.

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