LARGE INTESTINE

Large Intestine

Large Intestine
The large intestine is well

suited to its main functions

1.

2.

3.

4.

Absorption of water and electrolytes ***** Formation of the fecal mass from undigestible material, Production of abundant mucus that lubricates the intestinal surface. Intestinal bacteria also produce certain vitamins like vit. K and B12 *****

COLON

COLON and CECUM

The wall of the colon has the same basic layers as the

small intestine.
1. 2.

3.
4.

Mucosa Submucosa Muscularis Externa Serosa/ Adventitis

MUCOSA ( Colon)
Lumen is larger than that of

small intestine.** Luminal surface of the mucosa is smooth** No villi or plicae circulares ***** In undistended colon, the mucosa and submucosa exhibit temporary folds** Epithelium
simple columnar with numerous

goblet cells.**
Intestinal glands Lamina propria lymphatic nodules extending upto the submucosa Muscularis mucosae

Mucosa
Epithelium Simple columnar epithelium Colonocytes (absorptive cells) Short irregular microvilli** Goblet cells Goblet cells are numerous.** Increase in number towards terminal colon Mucous secreting cells (unicellular glands)

Submucosa
Connective tissue cells and fibers

Blood vessels
Nerves, Meissners plexus Lymphocytes and lymphatic nodules

Muscularis Externa ( Colon )

Two layers of smooth muscle modified Inner circular muscle layer continuous in the colon wall, Taeniae coli ***** outer muscle layer condensed into three broad, longitudinal bands Contractions of taeniae coli produces haustrations in the wall of colon Outer longitudinal muscle layer very thin often discontinuous found between the taeniae coli Myenteric (Auerbachs) nerve plexus parasympathetic ganglion cells Found between the two smooth muscle layers of the muscularis externa

Serosa (Colon)
Serosa (visceral peritoneum and mesentery) covers the cecum, transverse colon and sigmoid colon. small, pendulous protuberances of adipose tissue (appendices epiploicae)**

Colon- identification points

Lumen is wider No villi Taenia coli present More numerous goblet

cells

MEDICAL APPLICATION- CANCER

Approximately 9095% of malignant tumors of the

digestive system are derived from gastric or intestinal epithelial cells, usually in the large intestine. Malignant tumors of the colon are derived almost exclusively from its glandular epithelium (adenocarcinomas) and are the second most common cause of cancer deaths in the United States.

Appendix

Appendix
It is a blind evagination of the

cecum near the beginning of large intestine. Small and irregular lumen* Very Irregular, very few and widely placed crypts** Few goblet cells** No taeniae coli.** It has no function in digestion. It is a significant component of the MALT, with abundant lymphoid follicles in its wall.

Appendix
Mucosa Epithelium Simple columnar Few Goblet cells Lamina Propria Intestinal glands (Crypts of Liberkhun) Shorter and less dense tubular glands Lymphatic nodules***
Numerous Germinal centers Extend upto submucosa

Muscularis mucosae- incomplete Submucosa Numerous blood vessels Muscularis Externa Inner rcircular smooth muscles
Myenteric plexus

Outer longitudinal smooth muscles No taeniea coli**

Serosa- outermost coat

Appendix- identification points

Ring of lymph nodules No taenia coli Fewer crypts Indistinct muscularis

mucosae

MEDICAL APPLICATION
Appendix is a closed sac and its

contents are relatively static, it can easily become a site of inflammation (appendicitis). With the small lumen and relatively thin wall of the appendix, inflammation and the growth of lymphoid follicles in the wall can produce swelling that can lead to bursting of the appendix. Severe appendicitis is a medical emergency since a burst appendix will produce infection of the peritoneal cavity (peritonitis).

Rectum

Rectum
Temporary longitudinal folds (core of submucosa covered by mucosa) Mucosa Surface Epithelium
Simple columnar cells Striated border Goblet cells

Lamina Propria
Intestinal glands longer, close together, filled with goblet cells Adipose cells

Lymphatic nodules

Muscularis mucosae

Rectum
Submucosa

Muscularis Externa Inner circular Myenteric plexus ( parasympathetic ganglia) Outer longitudinal No taenia coli**
Adventitia/ Serosa Adventitia covers a portion of rectum, remaining is covered by serosa

Recto-anal junction

Recto-anal junction
Permanent longitudinal folds in

lower rectum and anal canal anal columns of Morgagni*** Depressions b/w the anal columns are called as anal sinuses. About two cm above the anal opening, at the recto-anal junction, the lining of the mucosa is replaced by stratified squamous epithelium. In this region, the lamina propria contains a plexus of large veins that, when excessively dilated and varicose, can produce hemorrhoids.**

Recto-anal junction
Muscularis mucosae and the

intestinal glands terminate Lamina propria is replaced by dense irregular connective tissue Submucosa merges with CT in the lamina propria of anal canal Internal hemorrhoidal plexus of veins lie in the mucosa of anal canal Muscularis Externa
Circular layer increases in thickness

in upper region of anal canal and forms internal anal sphincter In lower part it is replaced by skeletal muscles of external anal sphincter

Recto-anal junction