1. In
the
name of
Allah

2. Jejunum and ileum Rest of the small intestine
From duodenojejunal flexure
To ileocecal junction
Intraperitoneal
Attached to the posterior abdominal wall by mesentery of small intestine
Relations
Anterior abdominal wall
Greater omentum
Posterior abdominal wall
Retroperitoneal structures

3. Ileum Jejunum In umbilical region of peritoneal cavity
First 2:5 of small intestine
Diameter 4cm
Mucosal folds are large and frequent
Thicker wall
More vascular
Redder in life
Arterial arcade less
Aggregated lymphatic follicles are lesser
Intermesenteric fat less
In lower part of peritoneal cavity
Second 3:5 of small intestine
Diameter 3.5 cm
Mucosal folds are small and few
Thinner wall
Less vascular
Paler in life
Arterial arcade more
Aggregated lymphatic follicles are more
Intermesenteric fat more

5. Ileum
Ileal or Meckel’s diverticulum

6. Large intestine

7. Large intestine 1.5 m From caecum to anus Includes; Cecum and appendix
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anal canal

8. Large intestine Differs from small intestine in the:
More fixed in position
Greater caliber
Taeniae coli
Sacculation (haustration)
Appendices epiploic

9. Cecum In the right iliac fossa 6.5*7.5 cm Related posteriorly to the
iliacus & psoas mm
lateral cutaneous N of thigh
femoral nerve
Related anteriorly to the:
ant. Abdominal wall
Small intestine
Greater omentum

10. Caecum
Intraperitoneal
sup. & inf. Ileucecal and retrocecal recesses

11. ileocecal valve Sup & inf. Lip and frenulum Posteromedial of cecum
At the level of transetubercular and midclavicular lines

12. Vermiform appendix In the right iliac fossa McBurney’s point
2 cm below the ileocecal junction
Length 2-20cm average 9cm
Intraperitoneal
Position
Retrocecal & retrocolic 64%
Pelvic 30%
Subcecal 2.5%
pre and postileal 1.5%

13. Ascending colon 15 cm from cecum to hepatic flexure
Covered in front and sides by peritoneum
Taeniae coli ant., med. & lat.
Relation
Posteriorly
Quadratus and iliacus
Lateral cutaneous N of thigh
Iliohypogastric
Ilio-inguinal

14. Ascending colon Relations anteriorly Small intestine
Ant. Abdominal wall
Greater omentum

15. Right or hepatic flexure
Turns down and forward
Kidney posterior
Liver anterosuperior and lateral
Duodenum medial
Gall bladder anteromedial

16. Transverse colon 50 cm, from hepatic to splenic flexures
From Rt. Lumbar
To Lt. hypochondrium
Intraperitoneal and attached to the post. abdominal wall by meso.
Taeniae

17. Transverse colon Relations anterior Omentum Ant. abdominal wall
posterior
Pancreas
2nd part of duodenum

18. Lt. colic flexure Higher than right relations Spleen Pancreas
Lt. kidney
Phrenicocolic

19. Descending colon 25 cm from splenic flexure to pelvic brim Two parts
Covered anterioly by peritineum

20. Descending colon Relations: Anterior same as the right Posterior:
Kidney
Subcostal nerve
Iliohypogastric
Ilioinguinal
Lateral cutaneous N of thigh

21. Sigmoid colon 25- 40 cm from pelvic brim to S3 Has meso. Lateral limb
Medial limb in front of sacrum
Intersigmoid recess

22. Sigmoid colon Relations Posterior Rectum Sacrum Ureter Anterior Uterus
bladder

23. Rectum 10-15 cm From S3 To tip of coccyx continuous as the anal canal
Piercing pelvic diaphragm
Passing downward following the curve of sacrum
Deviate to the left and turns right
Rectal ampulla
Anorectal angle

24. Rectum
Peritonial covering
Muscular coat
Transverse fold

25. Rectum Relations: Posteriorly; Sacrum Coccyx Piriformis Coccygeus
Lavator ani
Sacral plexus
Sympathetic chain

26. Rectum Relations Anteriorly In male Sigmoid colon Ileum Bladder
Vas deferens
Seminal vesicle
prostate

27. Rectum Relations Anteriorly In female Sigmoid colon Ileum Rectouterine
(Douglas) pouch
Uterus
Vagina

28. Small and large intestine
Artery
Superior mesenteric (small & large)
Inferior mesenteric (large)
Internal iliac (rectum & anal canal)
Vein
Internal iliac (same as artery)

30. Anal canal 4-5 cm From the rectal ampulla To the anus Relations
Posteriorly
Anococcygeal body
Anteriorly
Male
Perineal body
Urogenital diaphragm
Urethra
Bulb of penis

31. Anal canal Female Perineal body Urogenital diaphragm Vagina Laterally
- Ischiorectal fossae

32. Anal canal Upper half Derived from endoderm Anal culumns Anal valves
Anal sinuses
Autonomic nerve
Sensitive to stretch
Artery and vein from and to inferior mesenteric

33. Anal canal Lower half Derived from ectoderm Has no anal columns
Somatic nerve, inferior rectal
Sensitive to pain, temperature, touch, pressure
Art. And vein from and to internal iliac
Pectinate line

34. Anal canal Muscle coat Internal sphincter (smooth muscle)
External sphincter
Subcutaneous
Superficial
Deep
Puborectalis
Anorectal ring
Puborectalis + internal sphincter + deep part of ext. sphincter

35. innervation
Autonomic
Somatic
Inferior rectal

36. Rectum and anal canal Blood supply Arteries: Superior rectal
Middle rectal
Inferior rectal
Veins: