SGD 15: Lower

Gastrointestinal Tract
University of Santo Tomas
1-C | C2 2020 MED
1. Differentiate the jejunum and ileum
with regards to its location, length,
diameter, thickness, color, intestinal
arcades, mesenteric fats, presence of
Peyers patch and mucosal fold.
 JEJUNUM Begins at duodenal flexure
ILEUM Terminates at ileocecal junction
JEJUNUM ILEUM

Location Upper part of the Lower part of the

peritoneal cavity cavity in the pelvis
below the left sde (RLQ)
of the transverse
mesocolon
(LUQ)

Color Reddish Brownish

Wall Wider, broader Thinner, narrower

thickness
Plicae Larger, more Upper widely
circulares numerous, closely separated
(Valves of set Lower - absent
Kerckring)
 JEJUNUM ILEUM
Mesentery Posterior abdominal wall Below and right of the aorta
attachment above and left of aorta
Mesenteric vessels 1 or 2 (few) arcades Many short terminal vessels
(arcades) Long & infrequent branches from 3 or 4+ arcades
Mesenteric fat Near mesentery root Throughout
deposition Scanty near intestinal wall Extends from root to intestinal
wall
Peyers patches NONE Present along antimesenteric
border
2. Discuss the different parts of the
large intestine as to its location
commencement, termination, and
average length.
 Cecum
Below the level of the
junction of ileum
2.5 inches (6 cm)
Blind ended pouch in the
right iliac fossa

Relations:
Anterior: coils of small
intestine, anterior abdominal
wall in right iliac region
Posterior: Psoas & iliacus
muscle, femoral nerve, lateral
cutaneous nerve of the thigh,
appendix
Medial: Appendix
Appendix
Narrow, muscular tube with large
amount of lymphoid tissue (3.5 in/
8-13 cm)
Base: attached to posteromedial
surface of cecum below the
ileocecal junction
Remainder: free
Mesoappendix appendicular
vessels and nerves
McBurneys point in relation to
abdominal wall: base is situated
1/3 of the way up the line joining
the right ASIS to the umbilicus
Appendix
Common positions:
1. Hanging down into the
pelvis against the right
pelvic wall
2. Coiled up behind the
cecum
3. Projecting upward along
the lateral side of the cecum
4. In front of or behind the
terminal part of the ileum.
Ascending Colon
RLQ - 5 in. (13 cm)
Cecum inferior surface of the right lobe of the
liver
Turns left right colic flexure (hepatic
flexure)
Relations:
Anterior: coils of small intestine, anterior
abdominal wall in right iliac region
Posterior: Iliacus, iliac crest, quadratus
lumborum, origin of transversus abdominis,
lower pole of right kidney
Transverse Colon
15 in. (38 cm)
Across the abdomen occupying the umbilical region
Begins: right colic flexure
Ends: left colic flexure

Relations:
Anterior: greater omentum, anterior abdominal
wall (umbilical and hypogastric regions)
Posterior: Second part of duodenum, head of
pancreas, jejunum coils, ileum
Descending Colon
About 10 in (25cm) long
Extends downward from Left colic
flexure to the pelvic brim
Anteriorly - Coils of small
intestine, Greater omentum,
Anterior abdominal wall
Posteriorly - Lateral border of left
kidney, Origin of transversus
abdominis muscle, Quadratus
lumborum, Iliac crest, Iliacus, Left
psoas, Iliohypogastric and
ilioinguinal nerves, lateral
cutaneous nerve of thigh, femoral
nerve
 Sigmoid Colon
10-15 inches long
Begins at the pelvic brim as a continuation of
descending colon to S3
Attached to posterior pelvic wall by the Sigmoid
mesocolon
Anteriorly - In the male: urinary bladder
In the female: posterior surface of uterus and upper part
of vagina
Posteriorly - Rectum and sacrum, also the lower coils of
terminal part of ileum
Rectum
About 5 inches long
Begins in front of S3 as continuation of sigmoid colon
Ends in front of tip of coccyx by piercing rectal
diaphragm and continuous with the anal canal
Puborectalis pulls the junction of the rectum and anal
canal producing the anorectal angle

Posteriorly - Sacrum and coccyx, Piriformis, coccygeus,

levatores ani muscles, Sacral plexus, Sympathetic
trunks
 Anteriorly - In male: Upper 2/3 of
rectum is covered in peritoneum and
is related to sigmoid colon and coils
of ileum (rectovesical pouch)
Lower 1/3 of rectum is devoid in
peritoneum and is related to posterior
surface of bladder, to termination of
vas deferens and seminal vesicles on
each side, and to prostate
In female: Upper 2/3 of rectum is
covered in peritoneum and is related
to sigmoid colon and coils of ileum
(rectouterine pouch/ pouch of
Douglas) Lower 1/3 of rectum is
devoid of peritoneum and is related
to the posterior surface of the vagina
3. Differentiate the small and large
intestines externally and internally.
 Small Intestine Large Intestine
EXTERNAL DIFFERENCE
Mobility Mobile Ascending and
Descending colon
FIXED
Cecum, Transverse,
Sigmoid Colon -
MOBILE
Capacity small large
Longitudina Continuous layer Collected into 3 bands
l Muscle with gut tenia coli (except at
appendix & rectum)
Appendices Absent Present
epiplociae
Intestinal Smooth Sacculated
wall
INTERNAL DIFFERENCE
Mucous Plicae Circulares Absent
Membrane (valves of
Kercking)
Villi Present Absent
Peyers Present Absent
4. Review the peritoneal coverings
and attachments of the small and
large intestine.
PERITONEUM
Thin serous membrane lining the walls of the
abdominal and pelvic cavities
Supports the abdominal organs

2 Layers: Visceral and Parietal Peritoneum

Peritoneal cavity
Peritoneal fluid
PERITONEUM
Peritoneal folds
Connect organs to each other or to the
abdominal walls
Serve as a means of conveying the blood
vessels, lymphatics and nerves to these
organs

1. Omentum
2. Mesentery
PERITONEUM
Greater sac
Greater Omentum/ Gastrocolic
From the greater curvature of the
stomach to the transverse colon
Looks down in front of the intestine before
curving back upwards to attach to the
transverse colon
Abdominal policeman
Lesser sac
Lesser Omentum/ Omental bursa
PERITONEUM
In the presence of infection,
The intestinal coverings tends to stick
together
The greater omentum may adhere to
other peritoneal surfaces around and a
focus of infection
OMENTUM FROM TO
Greater Greater Transverse
Omentum curvature of colon
stomach
Lesser Lesser Liver
Omentum curvature of
stomach
 LIGAMENTS FROM TO
Gastrosplenic Stomach Spleen
Ligament
Gastrophrenic Stomach Diaphragm
Ligament
Gastrocolic Stomach Transverse
Ligament Colon
Splenorenal Spleen Kidney
Ligament
Hepatogastric Stomach Liver
Ligament
 LIGAMENTS FROM TO
Falciform Liver Thoracic
Ligament Diaphragm,
Anterior Abdominal
wall
Round Ligament Liver Umbilicus
of Liver
Coronary Liver Thoracic
Ligament Diaphragm
Ligamentum Liver Liver
Venosum
Phrenicocolic Left Colic Thoracic
 LIGAMENTS FROM TO
Umbilical Folds Urinary Bladder
Ileocecal Folds Ileum Cecum
Broad Ligament Uterus Pelvic Wall
of the Uterus
Ovarian Uterus Inguinal canal
Ligament
Suspensory Ovary Pelvic Wall
Ligament of the
ovary
MESENTERIES FROM TO
Mesentery Small Intestine Posterior
(proper) (Jejunum & Abdominal Wall
Ileum)
Transverse Transverse Posterior
mesocolon colon Abdominal Wall
Sigmoid Sigmoid colon Pelvic wall
mesocolon
Mesoappendix
LIGAMENTS Mesentery
FROM of Appendix
TO
ileum
Hepatoduodena Duodenum Liver
l Ligament
PERITONEAL COVERING (OF
RECTUM)
First 1/3 covered anteriorly & posteriorly
Middle 1/3 covered only anteriorly
Lower 1/3 devoid of peritoneum
 5. Discuss with illustration the
neurovascular supply and lymphatic
venous drainage of the different
parts of the intestine.
Duodenum
Arterial Supply Upper - Superior
pancreaticoduodenal artery
(branch of gastroduodenal
artery)
Lower - Inferior
pancreaticoduodenal artery
(branch of superior mesenteric
artery)
Venous Drainage Correspond to the arteries
Innervation Celiac & Superior mesenteric
plexuses
Lymph Drainage Pancreaticoduodenal node ->
gastroduodenal nodes ->
Celiac nodes -> Superior
mesenteric nodes
Arterial supply
Venous Drainage
Innervation
Lymph drainage
Jejenum, Ileum, Cecum, & Ascending
Colon
Arterial Venous Innervation Lymph
Supply Drainage drainage
Jejenum & Superior Correspond to Superior Superior
Ileum mesenteric arteries Mesenteric mesenteric
artery Drains into plexus nodes
Ileocolic superior
artery mesenteric
lowest part of vein
ileum
Cecum Ileocolic Correspond to Superior Superior
artery arteries Mesenteric mesenteric
(branch of Drains into plexus nodes
Superior superior
mesenteric mesenteric
artery) vein
Ascending Ileocolic Correspond to Superior Superior
colon artery + right arteries Mesenteric mesenteric
colic artery Drains into plexus nodes
(branch of superior
Superior mesenteric
Arterial supply
Venous drainage
Innervation
Lymph drainage
Transverse Colon
Arterial Supply:
Proximal 2/3:
Middle colic
artery
Branch of Superior
Mesenteric artery
Distal 1/3: Left
colic artery
Branch of Inferior
mesenteric artery
Transverse Colon
Venous Drainage:
Proximal 2/3:
superior
mesenteric vein
Distal 1/3: into
inferior
mesenteric vein
Transverse Colon
Innervation:
Proximal 2/3:
superior
mesenteric
Distal 1/3:
splanchnic nerves
of the inferior
mesenteric
Transverse Colon
Lymph Drainage:
Proximal 2/3:
superior
mesenteric nodes
Distal 1/3: inferior
mesenteric nodes
Descending Colon
Arterial Supply:
Left colic
sigmoid
branches of the
inferior
mesenteric
artery
Descending Colon
Venous Drainage:
Correspond to
arteries
Drain into Inferior
mesenteric vein
Descending Colon
Innervation:
Sympathetic &
parasympathetic
nerves via inferior
mesenteric plexus
Descending Colon
Lymph Drainage:
Colic nodes
Drain into the inferior
mesenteric nodes
Sigmoid Colon
Arterial Supply:
sigmoid
branches of the
inferior
mesenteric
artery
Sigmoid Colon
Venous Drainage:
Correspond to
arteries
Drain into Inferior
mesenteric vein
Sigmoid Colon
Innervation:
Sympathetic &
parasympathetic
nerves via inferior
hypogastric
plexuses
Sigmoid Colon
Lymph Drainage:
Colic nodes
Drain into the inferior
mesenteric nodes
Rectum
Arterial Supply:
Superior rectal artery
from inferior mesenteric
artery
chief supply in mucous
membrane
Middle rectal artery
branch of internal iliac
artery
muscular coat
Inferior rectal artery
branch of internal
pudendal artery
anastomoses with middle
rectal at anorectal junction
Rectum
Venous Drainage:
Superior rectal vein
drains into inferior
mesenteric vein
Middle rectal vein
drains into internal iliac
vein
Inferior rectal vein
drains into pudendal vein

Union between rectal veins

forms portal-systemic
anastomosis
Rectum
Innervation:
Sympathetic &
parasympathetic
nerves from
inferior
hypogastric
plexus
(only sensitive to
stretch)
Rectum
Lymph Drainage:
Pararectal nodes
into Inferior
mesenteric nodes
 6. Draw the formation and
tributaries of the portal vein.
Portal Vein
Formed behind the neck of the pancreas
Union of the Superior Mesenteric and Splenic Veins
Drains blood from the
Lower third of the esophagus to halfway down the anal canal
Spleen, Pancreas and Gallbladder
Tributaries
Splenic Vein
Inferior Mesenteric Vein
Superior Mesenteric Vein
Left Gastric Vein
Right Gastric Vein
Cystic Vein