Abdominal region :

i) transpyloric plane L1
ii) subcostal plane L3
iii) intertrochanteric plane L5
iv) Rt & Lt midclavicular lines

Small intestine
- longest part of GIT extend from pyloris to ileocecal j(x)
- situated in the epigastric and umbilical regions
- into three parts: the duodenum, the jejunum, and the ileum
Duodenum
- C shaped tube
- 25cm long
- Receive opening of bile & pancreatic ducts
- Curve around d head of pancreas
- retriperinocal w exception of 2.5cm
- mucus membrane in 1st part
- others contain circular fold (plicae circularis)
Part of duodenum Explanation
1st part -begins at pyloris,run upward n backward on transpyloric plane L1
-5cm long
-gastroduodenal arteries lies posterior to it
-ulser easy to spread
2nd part -about 7.5cm
-runs vertically downward
-bile duct n main pancreatic pierce duodenal wall about ½ way down of
Its medial border ( junction of foregut n midgut)
-both ducts unite to form ampulla that opens on summit of major duodenal papilla
(guarded by spinchter of Oddi)
-accessory pancreatic duct (duct of santorini) open into minor duodenal papilla
3rd part -about 10cm
-runs horizontally to d left on subcostal plane
4th part -about 2.5cm
-runs up to n d left to d dudenojejunal flexure in position n attached to right crus of
diaphragm

Arteries supply Venous drainage Lymph drainage Nerve supply

- upper ½ by sup. -Upper ½ by sup. -Upper ½ - celiac nodes - sympathetic &
pancreaticoduodenal Pancreaticoduodenal parasympathetic (vagus
artery (gastroduodenal vein - portal vein nerve) thru celiac &
artery) sup.mes plexus
- lower ½ by inf. -lower ½ - sup.mes
pancreaticoduodenal -lower ½ by inf. nodes
artery (branch of Pancreaticoduodenal
sup.mes.artery) vein - sup.mes vein

Jejunum & Ileum

- about 3ft (6m) long
- jejunum begins at duodenojejunal flexure
- ileum ends at ileocecal j(x)
- coils of both r freely mobile & attached to post. abdomen wall by mesentery
- peritoneal fluid inside of peritoneal cavity
 Jejunum Ileum
-coiled at upper part of peritoneal cavity -coiled at lower part of peritoneal cavity & at pelvic
cavity
-wider,thicker,redder -smaller, widely separated
-more plicae circularis -less plicae circularis
-jejunum mesentery attach above & to left of aorta -jejunum mesentry attach below & to right of aorta
-less fat deposit -more fat deposit
-less arcades -more arcades
-no Peyer’s patches Peyer’s patches presence

Arteries supply Venous drainage Lymph drainage Nerve supply

- through jejunum & - correspond to arteries - pass thru many -sympathetic &
ileacecal artery from & drain to sup.mes vein mesenteric nodes & parasympathetic (vagus
sup.mes artery reach sup.mes nodes nerve) from sup.mes
- arteries reach intestine around origin of plexus
thru mesentry sup.mes artery at L1
- lower part of ileum
supplied by ileocolic
artery

Large Intestine
- extend from ileocecal j(x) to anus
- 1.5m in length
- consists of :
~ cecum ~ ascending colon ~ sigmoid
~ appendix ~ descending colon
~ rectum ~ tranverse colon

Cecum
- blind ended pouch in d Rt iliac fossa, below level of iliocecal j(x)
- about 6cm
- covered w peritoneum
- mobile but not mesentery
- longitudinal muscle – restricted to 3 flat bands (Taniae coli that converge on d base of
appendix )
- distended w gas
- ileocecal valve is provided w 2 folds (no role in preventing reflux)
- appendix communicate w cecum thru opening above & below ileocecal opening

Arteries supply Venous drainage Lymph drainage Nerve supply

- ant. & post. cecal - correspond to arteries - thru several mes. nodes - sympathetic &
artery from ileocolic & drain to sup.mes vein & reach sup.mes lymph parasympathetic (vagus)
artery (branch of nodes nerves form the sup.mes.
sup.mes artery) plexus
Appendix
- narrow,muscular tissue contain lymph tissue (defense mech.)
- variable in length
- base attached to post. medial surface of cecum about 2.5cm below iliocecal j(x)
- mobile or free w no base
- no base
- has mesoappendix which contain vessel & nerves
- base is at 1/3 of way up line joining Rt. ASIS to ambilicus (Mc Burney’s point)
- complete peritoneal covering

Arteries supply Venous drainage Lymph drainage Nerve supply

- appendicular artery is - appendicular vein - drain into one or two - sympathetic &
branch of post.cecal drains into post. cecal nodes lying in the parasympathetic (vagus)
artery from ileocolic vein mesoappendix & then nerves form the sup.mes.
artery eventually into the plexus
sup.mes nodes

Ascending colon
- from cecum to Rt colic flexure(hepatic flexure) - continuous with the transverse colon.
- about 13cm - lies in the right lower quadrant
- covered ant. by peritoneum

Arteries supply Venous drainage Lymph drainage Nerve supply

- thru ileocolic & right - correspond to the - drain into lymph nodes - sympathetic &
colic branches of the arteries &drain into the lying along d course of d parasympathetic (vagus)
superior mesenteric sup. mes vein colic blood vessels & nerves form the sup.mes.
artery ultimately reach sup. plexus
mes nodes

Transverse colon
- about 38cm - has mesentery (transverse mesocolon)
- occupy umbilical region - left colic flexure is higher than right colic flexure
- from hepatic flexure to splenic flexure
- ascends to left colic flexure below the spleen
- suspended from diaphragm by phrenicocolic ligament

Arteries supply Venous drainage Lymph drainage Nerve supply

- proximal 2/3 r supplied - correspond to arteries - proximal 2/3 drain into - proximal 2/3 r
by middle colic artery,a & drain into superior & colic nodes & then into innervated by
branch of the sup. mes inf. mes veins sup. mes nodes sympathetic
artery - distal third drains into & vagal nerves thru sup.
- distal third is supplied colic nodes & then into mes plexus
by left colic artery,a inf. mes nodes. - distal third is
branch of inf. mes artery innervated by
sympathetic &
parasympathetic pelvic
splanchnic nerves thru
inf. mes plexus.

Descending colon
- about 25cm
- extent from Lt colic flexure to pelvic brim, where it becomes continuous w sigmoid colon
- peritoneum covers front & sides & binds it to post.abdominal wall
Arteries supply Venous drainage Lymph drainage Nerve supply
- left colic & sigmoid - correspond to arteries - drains into colic lymph - sympathetic &
branches of the inf. mes & drain into the inf. mes nodes & inf. mes nodes parasympathetic pelvic
artery vein around origin of inf. splanchnic nerves thru
mes artery inf. mes plexus

Sigmoid colon
- 25-40cm
-continuation of descending colon in front of pelvic brim (entrance)
- continous w rectum (3rd sacral vertebrae)
- mobile
- has sigmoid mesocolon (volvolus)

Differences Between the Small and Large Intestine

Small intestine Large intestine

-small lumen -large lumen
-middle of abdomen -peripheral abdomen
-no teniae coli -has teniae coli
-no portal circulation -has portal circulation
-mobile except duodenum -ascending & descending parts of colon r fixed
-has a mesentery that passes downward across -absence of mesentery
midline into right iliac fossa
-small intestine has no fatty tags attached to its wall -has fatty tags, called the appendices epiploicae
-wall of the small intestine is smooth -large intestine is sacculated
-mucous membrane has permanent folds, called -absence of plicae circulares
plicae circulares
-mucous membrane has villi -absence of villi