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    Anatomy and Physiology of Small and Large Intestines, Rectum and Anus

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    Elmer Patrick
    The small intestine is responsible for nutrient digestion and absorption. It develops from the midgut tube and contains villi and crypts that increase surface area for absorption. The large intestine develops from the hindgut tube and its main functions are water absorption and housing gut microbiota which produce vitamins and digest fiber. The anus and rectum are the terminal portions of the gastrointestinal tract, with sphincters that control defecation.

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    Anatomy and Physiology of Small and Large Intestines, Rectum and Anus

    Uploaded by

    Elmer Patrick
    149 views24 pages
    The small intestine is responsible for nutrient digestion and absorption. It develops from the midgut tube and contains villi and crypts that increase surface area for absorption. The large intestine develops from the hindgut tube and its main functions are water absorption and housing gut microbiota which produce vitamins and digest fiber. The anus and rectum are the terminal portions of the gastrointestinal tract, with sphincters that control defecation.

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    anatomy and physiology of small and large intestines, rectum and anus

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    anatomy and physiology of small and large intestines, rectum and anus

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    The small intestine is responsible for nutrient digestion and absorption. It develops from the midgut tube and contains villi and crypts that increase surface area for absorption. The large intestine develops from the hindgut tube and its main functions are water absorption and housing gut microbiota which produce vitamins and digest fiber. The anus and rectum are the terminal portions of the gastrointestinal tract, with sphincters that control defecation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    149 views24 pages

    Anatomy and Physiology of Small and Large Intestines, Rectum and Anus

    Uploaded by

    Elmer Patrick
    The small intestine is responsible for nutrient digestion and absorption. It develops from the midgut tube and contains villi and crypts that increase surface area for absorption. The large intestine develops from the hindgut tube and its main functions are water absorption and housing gut microbiota which produce vitamins and digest fiber. The anus and rectum are the terminal portions of the gastrointestinal tract, with sphincters that control defecation.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 24

    Anatomy and

    Physiology of the
    Small Intestine,
    Large Intestine,
    Rectum and Anus
    Embryology of the Small Intestine
    • Gut tube  foregut, midgut, hindgut
    • Foregut: duodenum
    • Midgut: small intestine, ascending colon, proximal
    transverse colon (SMA)
    • Hindgut: distal transverse colon, descending colon,
    rectum, anus (IMA)
    • Gut tube: initially connects to yolk sac via vitelline
    duct (Meckel’s diverticulum)
    Embryology
    • 5th week: extracoelomic herniation of developing
    bowel and 270◦ counterclockwise rotation
    • 10th week: retraction back into the abdominal
    cavity
    • Intestinal atresias: ischemic episodes after
    organogenesis
    A &P of the Small Intestine
    • Principle site of nutrient digestion and absorption.
    • From pylorus to cecum
    • 4-6 meters
    • Components:
    • Duodenum (retroperitoneum), jejunum, ileum
    • Pylorus Duodenum ligament of Treitz  jejunum
    • Jejunoileal segment:
    • proximal 40% jejunum,
    • distal 60% ileum
    • Ileocecal valve
    • Mucosal folds: plicae (folds) circulares (circular) /
    valvulae conniventes vs colon
    • Difference between jejunum and ileum: jejunum
    has larger circumference, thicker wall, less fatty
    mesentery, and longer vasa recta
    Blood Supply
    • Foregut: Proximal to 2nd part of duodenum (major
    duodenal papilla): Gastroduodenal artery, superior
    pancreaticoduodenal artery. (Celiac axis)
    • Midgut: distal to 2nd part of duodenum: SMA
    • SMV
    Layers of the small intestine (from innermost to outermost
    layers): mucosa, submucosa, muscularis propria, serosa
    • Mucosa: epithelium (absorption), lamina propria
    (connective tissue), muscularis mucosae (smooth muscle)
    • Villi and crypts (of Lieberkuhn)
    • Submucosa: strongest layer
    • Villi: finger-like projections of epithelium and
    undryling lamina propria
    • Blood and (lacteals) lymphatic vessels
    • Crypts: epithelial cellular proliferation
    • Bmi-1-positive cells: quiescent, radio-resistant cells
    induced by injury
    • LGR-5-positive cells: radiation-resistant cells, facilitate
    homeostatic vs injury-induced regeneration
    • Stem cells
    •  enterocytes/goblet cells/enteroendocrine
    cells/Paneth cells
    • Regenerate in 2-5 days
    • Resilient mucosa
    • Uniquely susceptible to radiation and chemotherapy
    • Enterocytes: predominant absorptive cell of the
    intestinal epithelium
    • Apical site (lumen-facing):
    • Digestive enzymes, transporter mechanisms, microvilli (40x
    increase in absorptive surface area)
    • Goblet cells: mucin (defense against pathogens)
    • Enteroendocrine cells: secretory
    • Paneth cells: growth factors, digestive enzymes,
    antimicrobial peptides
    • Immune system: M-cells, intraepithelial
    lymphocytes
    Physiology of the Small Intestine
    • Digestion and absorption
    • Absorbs 80% (7,5k) of 9L fluid from upper GI
    • Glutamine: major energy source for enterocytes
    • Principal site of lipolysis: proximal intestine
    • Proximal jejunum: absorption of lipids
    • Terminal ileum: bile salts, Vitamin B12, fatty acids
    • Calcium citrate > calcium carbonate (gastric bypass)
    • Immunity:
    • Peyer’s patches: most prominent aggregates of
    lymphoid follicles and is a local source of IgA
    • Intestinal adaptation
    • Epithelial cellular hyperplasia: few hours after bowel
    resection
    • Humans: postresection intestinal adaptation within 1-2
    years
    • Compensation: ileum > Jejunum
    • Small bowel resection
    Representative Regulatory Peptides produced in
    the small Intestine:
    Embryology of the Large Intestine
    • Hindgut: distal transverse colon, descending colon,
    rectum, anus (IMA)
    • Cloaca: distal-most end of hindgut
    • Divided by urorectal septum into the urogenital sinus and
    rectum
    • Distal anal canal: endoderm
    • Dentate line: endodermal hindgut, ectodermal hindgut
    • Internal pudendal artery
    A & P of the Large Intestine
    • Hindgut: distal transverse colon, descending colon,
    rectum, anus (IMA)
    • Cloaca: distal-most end of hindgut
    • Divided by urorectal septum into the urogenital sinus and
    rectum
    • Distal anal canal: endoderm
    • Dentate line: endodermal hindgut, ectodermal hindgut
    • Internal pudendal artery (from IIA)
    A & P of the Large Intestine
    • Landmarks:
    • Colon: begins at junction of terminal ileum and cecum
    • Extends ~150 cm to the rectum
    • Sacral promontory: rectosigmoid junction,
    • Teniae coli coalesce to form outer longitudinal smooth muscle
    layer of rectum
    • Ascending colon: fixed to retroperitoneum
    • Hepatic flexure: transition to transverse colon
    • Splenic flexure: descending colon (lienocolic ligament)
    A & P of the Large Intestine
    • Cecum: widest diameter of colon (7.5-8.5 cm),
    thinnest muscular wall (perforation, obstruction)
    • Sigmoid colon: narrowest portion of colon, most
    mobile (diverticulitis, volvulus)
    Blood Supply of the Large Intestine
    • SMA
    • Ileocolic artery (absent in 20%): terminal ileum and
    proximal ascending colon
    • Right colic: ascending colon
    • Middle colic: transverse colon
    • IMA
    • Left colic: descending colon
    • Sigmoidal branches: Sigmoid
    • Superior rectal: proximal rectum
    • Anastomosis: marginal artery of Drummond (15-
    20% of the population)
    A & P of the Anus and Rectum
    • Landmarks:
    • Rectum: 12cm in length
    • Anus:
    • Valves of Houston: three distinct mucosal folds
    • Fascia
    • Presacral fascia: separates rectum from presacral venous
    plexus and pelvic nerves
    • Rectosacral fascia (Waldeyer’s fascia): attaches to fascia
    propria at anorectal junction
    • Denonvillier’s fascia: rectum from prostate/seminal vesicles or
    vagina
    • Lateral Ligaments: lower rectum
    A & P of the Anus and Rectum
    • Anatomic anal canal
    • From dentate/pectinate line to anal verge
    • Dentate/pectinate line: proctodeum-hindgut transition
    (columnar  squamous)
    • Transition zone: up to 15cm from dentate line
    • Surrounded by columns of Morgagni (longitudinal mucosal
    folds)
    • Source of cryptoglandular abscess

    • Surgical anal canal


    • From anorectal junction to anal verge
    • 2-4 cm (men > women)
    A & P of the Anus and Rectum
    • Internal anal sphincter
    • Inner smooth muscle
    • surrounded by subcutaneous, superficial, and deep
    external sphincter
    • External anal sphincter
    • Extension of puborectalis muscle
    • Pelvic floor: puborectalis, iliococcygeus,
    pubococcygeus muscles
    Blood supply of the Anus and
    Rectum
    IMA
    • Superior rectal artery: upper 2/3 rectum
    • (Internal Iliac  Middle rectal artery)
    • Internal Pudendal
    • Inferior rectal: lower rectum

    Superior rectal vein  IMV  portal vein


    Middle rectal vein  internal iliac vein
    Inferior rectal vein  internal pudendal  internal
    iliac
    A & P of the Anus and Rectum
    • Colon: major site of water absorption, electrolyte
    exchange (90% or 1-2 L /day up to 5 L)
    • Decreased pH (lactulose etc) and colonic bacteria:
    decreased ammonia absorption
    • SCFA: important source of colonocytes
    • Anaerobes > aerobes
    • Colonic bacteria: vit K production
    • Motility: intermittent (vs cyclic) contractions

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