Small and Large Intestine

8/3/2019 Small and Large Intestine

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SMALL AND LARGEINTESTINE


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Small Intestine

Divided into three parts.Length is ~7mts

Duodenum 25cm, four parts Ampulla in 2ndpart

Jejunum-proximal 2/5 Valvulae conneventes 2 arcades in mesentery

Ileum-distal 3/5 Characterless Many arcades in mesentery


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The differences between the ileal arteries and the jejunal arteries

can be summarized as follows:

Type Appearance Number of

arcades

Layer of

fatJejunal

arteries

one (or few) thin

Ileal

arteries

many thick


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Intestinal Villi A series of fingerlike projections in mucosa

Covered with microvilli

Microvilli are brush border

Villi contain capillary and lacteal

Lacteal- specialized lymph capillary used in

lipid transport


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Villi fingerlike

projections onmucosa

Surface cellsfor absorption

Containscapillary bedand lacteal(lymphcapillary)


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Microvilli

tiny plasma

membraneprojections ofabsorptive cells ofmucosa

Fuzzy appearancecalled brush border

Brush borderenzymes locatedhere


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The Large Intestine Is horseshoe-shaped

Extends from end of ileum to anus, comprising of

Appendix, cecum, ascending, transverse,

descending, sigmoid colon and rectum

Lies inferior to stomach and liver

Frames the small intestine

Is about 1.5 meters long and 7.5 cm wide


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Ileocecal Valve


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Muscles

The longitudinal layer of the muscularisexterna is reduced to the muscular bands oftaeniae coli

3 longitudinal bands of smooth muscle(taeniae coli):

run along outer surfaces of colon

deep to the serosa Muscle tone in taeniae coli creates the

haustra


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CONSTIPATION


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Definition:M

25-40yr

Pathology:

Ileal-60%Deep ulcers

Cobble stone appearance

Fistulas

Skip leisionsTransmural

C/F: Diarrhoea, pain,perianal abscess,

fissure

Cobble stone

appearance


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Treatment:

Steroids, ASA

Sx for complicationsAnal disease- I&D

String sign of Kantor


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Skip lesions, deep mucosal ulcers, Transmural inflammation


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TUBERCULOSIS OF INTESTINE

Involves ileum, proximal colon, peritoneumStasis, decreased acid ileal disease

ULCERATIVE

sec to pul TB, ingestion of bacilli

Multiple transverse ulcers in ileumDiarrhoea, wt loss

Rx. Chemotherapy

HYPERPLASTIC

Ingestion of resistant MTB

Infection in follicles

Thick wall and intestinal obstruction

Pain ab, RIF mass

Rx. chemotherapy


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Amoebiasis


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TUMOURS OF SMALL INTESTINE

Benign: Malignant:Adenoma, lipoma Carcinoma

leiomyoma, Carcinoid-Appendix,

ileum, rectum

Peutz-Jeghers synd - liver mets>carcinoidFamilial syndrome

Intestinal hamartomas - 5HIAA in urine

Jejunal polyps

Melanosis of lips,

perianal skin


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TUMOURS OF LARGE INTESTINE

BENIGN:(polyps)

InflammatoryMetaplastic

Hamartomas( Peutz-Jeghers, juvenile)

Neoplastic

FAMILIAL ADENOMATOUS POLYPOSIS

Thousands of polyps in colon

Dominant inheritance

A/W-desmoid, osteomas, epidermal cysts

Dx- sigmoidoscopy->100c/f- diarrhoea, wt loss, bleeding P/R

Familial screening

Rx- Colectomy


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Malignant tumours of large intestine

ADENOCARCINOMA

>50yr age gpAnnular, tubular, ulcerative, cauliflower

Left colon: Stenosing, obstruction

alternating constipation

diarrhoeaSigmoid: Pain, tenesmus

Transverse colon: Anaemia, lassitude

Right colon: Anaemia, RIF mass

Sigmoidoscopy, colonoscopy,double contrast,

apple core appearance

Rx: Resection


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FECAL FISTULA


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FECAL FISTULA

Previous surgery is most common cause

High output >1 lit/dayLow output


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Small and Large Intestine

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