Anatomía: Sistema Renal, Reproductor, Digestivo, Endocrino y Metabólico (PDF)

lesson-4-anato-IV.pdf user_1680833 Anatomía: sistema renal, reproductor, digestivo, endocrino y metabólico 2º Grado en Medicina Facultad de Ciencias de la Salud. Campus de Alfara Universidad CEU Cardenal Herrera...

lesson-4-anato-IV.pdf user_1680833 Anatomía: sistema renal, reproductor, digestivo, endocrino y metabólico 2º Grado en Medicina Facultad de Ciencias de la Salud. Campus de Alfara Universidad CEU Cardenal Herrera Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  UNIT 4 – LARGE INTESTINE. RECTUM LARGE INTESTINE Last chance for absorption, after 7 meters of digestive tube Here the water is absorbed from the residues that are not digestible - So the chyme begins being liquid and is converted into solid feces The feces will be stored until the moment of defecation The colon forms an arch that encircles the small intestine. Parts: - Cecum - Appendix - Ascending colon - Transverse colon - Descending colon - Sigmoid colon - Rectum - Anal Canal APPEARANCE OF THE LARGE INTESTINE Things that the large intestine has and the small intestine doesn’t: - A larger diameter - Omental appendices: projections of fat that arises from the large intestine - Haustra: dilations of the colonic wall between the tenia - Teniae coli a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  TENIAE COLI Teniae coli: longitudinal bands formed by smooth muscle forming 3 thickened bands: - Mesocolic tenia: place of attachment of Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. the: § Transverse mesocolon § Sigmoid mesocolon - Omental tenia: place of attachment of the: § Omental appendices - Free tenia or Tenia libera: nothing attaches to it Their contraction produces bags between them called haustra Beginning: at the base of the appendix - The longitudinal layer of the appendix separate them into 3 bands Continuation: they run through the whole length of the intestine Ending: at the recto-sigmoid joint - They merge and constitute the thick longitudinal layer of the rectum PARTS OF LARGE INTESTINE CECUM First part of the large intestine It continues with the ascending colon Peritoneum: almost completely covered by peritoneum, but it does not have a mesentery - Despite this, it has a reasonable mobility Location: inguinal fossa, but it can move freely inside it Palpation: You can touch it at the anterior abdominal wall if is full of feces or gas a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas Anatomía: sistema renal, rep... Banco de apuntes de la  IRRIGATION OF CECUM Arterial supply: - Superior mesenteric artery → Ileocolic artery: which in fact is its terminal branch, irrigates all the cecum Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - The ileocolic artery gives an appendicular branch for the appendix Venous drainage: - Ileocolic vein →superior mesenteric vein→hepatic portal vein ILIOCECAL JUNCTION The ileum ends entering at the cecum in an oblique way, invaginating into it Ileocecal valve: or Tulp’s valve, located in the last fold of intestine It is surrounded by two folds called Ileocolic lips that merge in the frenula Undemonstrated theory: The lips can contract for close the valve and prevent the cecal-ileal reflux However, the circular layer of muscle is not very well developed and not strong enough for act as an sphincter a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  The visualization of the Tulp’s valve in a colonoscopy means that the whole colon has been explored Bow and arrow sign: if you make a semicircle in the hole of appendix and a perpendicular line (like a bow and arrow) the arrow points at the ileocecal valve Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. VERIFORM APPENDIX Blind intestinal diverticulum that contains masses of lymphoid tissue About 10 cm in length It arises from the cecum inferior to the ileo-cecal junction The position of the appendix is variable, but it is usually retrocecal MESOAPPENDIX Mesentery of the appendix Very short Triangular shape It derives from the mesentery of the terminal ileum It attaches to the cecum and the proximal segment of appendix Lymph drainage: - The lymph is collected through small appendicular nodes and vessels located at the mesoappendix a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  - They go to the ileocolic nodes, located in the path of ileocolic artery - Then the lymph go to the superior mesenteric nodes → Celiac nodes ASCENDING COLON Beginning: cecum Path: it ascends on the right side of the abdominal cavity - Right paracolic gutter: peritoneal groove between the lateral abdominal wall and the ascending colon Ending: right colic flexure, also called hepatic flexure because it is related to the right lobe of the liver - The flexure is located at the level of the 9/10th ribs - The liver is anterior to the colon, so the flexure is covered by it a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  It is narrower than the cecum It is secondarily retroperitoneal It is covered by peritoneum in the anterior and both lateral surfaces Its mesentery is very short or absent The greater omentum separates the ascending colon from the anterior abdominal wall Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. ARTERIES ASCENDING COLON Superior mesenteric artery→Ileocolic and right colic arteries - They anastomose between them and also with the right branch of the middle colic artery - This is the first anastomosis of a series of arches that continues with left colic and sigmoid arteries (from inferior mesenteric artery) - This forms a continuous arterial channel called marginal artery or juxtacolic artery, which extends during all the mesenteric border length VENOUS AND LYMPH DRAINAGE OF ASCENDING COLON Venous drainage: - Ileocolic and right colic veins - → superior mesenteric vein Lymph vessels: - Epiploic and paracolic nodes → - →Ileocolic and intermediate right colic nodes → - → Superior mesenteric nodes → - →Celiac nodes a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  TRANSVERSE COLON The longest and most mobile segment Beginning: right colic flexure Ending: left colic flexure, which is respect to the right flexure: Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - More superior - More angled - Less mobile Phrenicocolic ligament: from Left colic flexure to the diaphragm Position may change: normally at L3 (umbilicus), but in thin people can descend to pelvis (right picture) a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Aguas Minerales de España | aneabe - Cuando estudies, ten siempre a mano tu botella de agua mineral  TRANSVERSE MESO COLON It is fused with the posterior wall of omental bursa Its root follows the inferior border of the pancreas It divides the descending portion of duodenum in two parts It continues with parietal peritoneum posteriorly Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Superior mesenteric artery →Middle colic artery Transverse colon can also receive blood from the anastomosis of the right/left colic arteries These anastomosis are part of the arcades of the marginal arteries a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  Venous drainage: - Middle colic vein → - → Superior mesenteric vein Lymphatic drainage: - Middle colic nodes - →Superior mesenteric nodes - →Celiac nodes Innervation - Superior mesenteric plexus → - →Periarterialplexuses (right/middle colic arteries) § Sympathetic § Parasympathetic § Afferent visceral - a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  DESCENDING COLON Beginning: left colic flexure Path: descends anterior to the left kidney Ending: sigmoid colon, at the iliac fossa Secondarily retro-peritoneal. Peritoneum covers the Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. anterior and lateral surfaces In about 33% of the people the mesentery is very short, so short that is not very common to have volvulus here Paracolic gutter in the lateral aspect SIGMOID COLON “Sigmoid” due to the Greek letter Sigma Beginning: ending of descending colon in iliac fossa Ending: rectosigmoid junction (S3), marked by the ending of the teniae coli, which disappear as the longitudinal muscle of the rectum Omental appendices: they become long and disappear at the ending of the sigmoid mesentery SIGMOID MESO COLON Long mesentery that allows a very high freedom of movement - This also causes many volvulus in the sigmoid colon Root of the sigmoid mesocolon: extends along the external iliac vessels and later follows the common iliac vessels to end at the sacrum Retroperitoneally, posterior to the root of the mesocolon we have the left ureter and the division of the common iliac vessels a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  ARTERIAL SUPPLY OF DESCENDING AND SIGMOID COLON The left colic flexure marks the division of midgut/hindgut and the limit between the irrigation of superior and inferior mesenteric artery Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. Inferior mesenteric artery → Left colic and sigmoid arteries Sigmoid arteries→Ascending and descending branches - The most superior branch anastomoses with the descending branch of left colic artery (marginal artery) VENOUS DRAINAGE OF DESCENDING AND SIGMOID COLON Inferior mesenteric vein → →Splenic vein→ →Hepatic portal vein a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  LYMPHATIC DRAINAGE OF DESCENDING AND SIGMOIF COLON Epicolic nodes (most superior part)→ →Paracolic nodes (yellow in the picture)→ →Colic nodes (located in the path of left Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. colic artery)→ →Inferior mesenteric nodes (along the inferior mesenteric artery) Logically, lymph of the left colic flexure may drain to the superior mesenteric nodes INNERVATION Proximal to left colic flexure: both sympathetic and parasympathetic: - Abdominal aortic plexus → periarterial plexuses Distal to left colic flexure - Sympathetic: lumbar part of the sympathetic trunk → lumbar splanchnic nerves → superior mesenteric plexus→periarterial plexus (along the inferior mesenteric artery)→ Descending colon and sigmoid - Parasympathetic: inferior hypogastric plexus→It ascends retroperitoneally to the descending colon and sigmoid a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  RECTUM Terminal part of the large intestine At the fetus the rectum is first retroperitoneal, but later subperitoneal It begins at S3 level, continuous with sigmoid colon. At this point: - The sigmoid mesocolon ends - The teniae coli spread and become a continuous longitudinal layer of smooth muscle - The omental appendices appear discontinued Its terminal end is the anal canal Despite the name, the rectum is not “rectus”, because it has the shape of an S due to two flexures: - Sacral flexure when it follows the normal curvature of sacro- coccyx - Ano-rectal flexure: a 80o postero- inferior angle when the rectus perforates the pelvic diaphragm § This flexure allows the fecal continence when this angle is maintained thanks to the action of puborectalis muscle In an anterior view you can see three lateral flexures of the rectum: - Superior flexure on the left side - Intermediate flexure on the right side - Inferior flexure on the left side The causes of these flexures are the three internal transverse rectal folds a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  The cause of these flexures are the three internal transverse rectal folds They are thickenings of the circular muscle layer: - Superior fold on the left side Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - Middle fold on the right side - Inferior fold on the left side AMPULLA OF RECTUM Terminal segment of the rectum Here is where the feces are stored until they are expelled at the defecation It is supported by the - Pelvic diaphragm - Anococcygeal ligament RECTUM AND PERITONEUM The rectum is covered by peritoneum (blue area at the picture) at these surfaces: - Superior third: Anterior and lateral surfaces - Middle third: Anterior surface only - Inferior third: no surface (it is subperitoneal) Males : the peritoneum continues from rectum to the posterior wall of bladder: floor of recto-vesical pouch Females : the peritoneum continues from rectum to the posterior surface of the vagina’s fornix: floor of the recto- uterine pouch Both sexes: laterally the peritoneum form two pararectal fossae which allows the rectum to distend when it receives the feces At the picture, the pouches are marked with a 6 a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  RELATIONS OF RECTUM Posterior surface: - S1, S2, S3 - Coccyx Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - Anococcygeal ligament - Median sacral artery and vein - Inferior ending of the sympathetic chain and sacral plexus Anterior surface - Females : § Vagina (between them there is the recto-uterine pouch) § Below the pouch, there is a recto- vaginal septum, very weak - Males: § Urinary bladder (between them there is the recto- vesical septum) § Ureters § Ductus deferens § Seminal glands § Prostate ARTERIES OF RECTUM Superior rectal artery from the inferior mesenteric artery irrigates the proximal portion of the rectum Middle rectal arteries from the internal iliac artery irrigates the middle and distal portion of the rectum Inferior rectal arteries from the internal pudendal artery for the anorectal junction and anal canal Anastomosis: superior and inferior rectal arteries Less common are the anastomosis between both middle rectal arteries a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  VENOUS DRAINAGE OF RECTUM Submucosal rectal plexus surrounds the rectum and it can communicate with: - Vesical venous plexus in males Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - Uterovaginal venous plexus in females Then the blood can follow two paths depending on the level: - Portal path: § Superior rectal vein drains into the inferior mesenteric vein→splenic vein→hepatic portal vein - Systemic path § Middle rectal vein → internal iliac vein § Inferiorrectalvein→internalpudendal vein→internal iliac vein NERVES OF RECTUM Sympathetic - Lumbar spinal cord (T12-L2)→ Lumbar splanchnic nerves → - Synapsis at the prevertebral sympathetic ganglia - Postsynaptic fibers through different ways: § Periarterial plexus of the superior rectal artery (superior rectal nerves) § Periarterial plexus of inferior mesenteric artery § Hypogastric plexuses – Pelvic plexus Parasympathetic - From S2–S4 → pelvic splanchnic nerves→ - →Left/Rightinferior hypogastric plexus→ - Synapsis at the wall of the viscera Visceral afferent fibers - Because we are inferior to the PPP, the pain follows retrogradely the parasympathetic path a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  ANAL CANAL Beginning: superior aspect of the pelvic diaphragm, where the rectal ampulla becomes narrow due to the puborectalis muscle Ending: anus Length: 3-4 cm Diameter: normally is collapsed except during defecation a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  The canal descends between: - The perineal body - The anococcygeal ligament At the canal we can find two sphincters: - Internal involuntary Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - External voluntary Relaxation of both sphincters causes the defecation EXTERNAL SPHINCTER Voluntary It surrounds the inferior two thirds of the anal canal It continues superiorly with the puborectalis muscle It is attached - Anteriorly to the perineal body - Posteriorly to the coccyx through the ano-coccygeal ligament Innervated mainly by inferior rectal nerve (S4), a branch of pudendal nerve - “Mainly” because it receives also innervation of the levator ani nerve, very useful for contract it synchronously with the pubo- rectalis muscle a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Aguas Minerales de España | aneabe - Cuando estudies, ten siempre a mano tu botella de agua mineral  INTERNAL SPHINCTER Involuntary It surrounds the superior 2/3 of the anal canal Sympathetic: contracts the sphincter Its fibers come from 2 plexuses Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. - Superior rectal plexus - Hypogastric plexus Parasympathetic: inhibits the contraction of the sphincter - Intrinsic stimulation: peristaltism - Extrinsic stimulation: pelvic splanchnic nerves HOW DO SPHINCTERS WORK? The internal sphincter normally is contracted - This prevents the escape of feces or flatus However, the distension of the rectal ampulla when it is full causes a peristaltic movement that relaxes the internal sphincter At this moment, you have to voluntarily contract the external sphincter if you don’t want to evacuate When the peristaltic wave finishes, the ampulla relaxes and the internal sphincter recovers its tonus until the next peristaltic wave There is a limit: there is one moment when the internal sphincter is not able to contract until the evacuation a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  ANAL COLUMNS Anal columns: ridges of the mucosa located at the superior half of the anal canal Here we can find the terminal branches of superior rectal artery/vein The superior border of the columns is the anorectal junction, where the ampulla suddenly narrows for cross the pelvic diaphragm Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. The inferior border of the columns has anal valves Between the columns and the valves there are anal sinuses that secrete mucus for help in the defecation The inferior border of the anal valves forms the pectinate line, that divides the anal canal into two parts with different irrigation/innervation: - Over the pectinate line is visceral, derived from the hindgut - Below the pectinate line is somatic, derived from the proctodeum a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Vaya taco de apuntes que te estás comiendo ¿No te apetecen unas pipas de girasol? - @quieromispipas  ARTERIES OF ANAL CANAL Superior rectal artery: from inferior mesenteric artery irrigates the area over the pectinate line Middle rectal artery from internal iliac artery Inferior rectal artery from the internal pudendal artery (from the internal iliac artery) irrigate: - The area below the pectinate line - The surrounding muscles - The perianal skin Anastomosis between the three rectal arteries may occur VENOUS DRAINAGE OF ANAL CANAL Area superior to the pectinate line → Superior rectal vein → Inferior mesenteric vein → Splenic vein → Hepatic portal vein Area inferior to the pectinate line → - → Middle rectal vein → Internal iliac vein → Inferior vena cava - → Inferior rectal vein → Internal pudendal vein → Internal iliac vein Anastomosis between the three veins Arteriovenous shunts are frequent (without capillaries) LYMPHATIC DRAINAGE OF ANAL CANAL Superior part of the rectum: - →Sacral nodes - →Inferior mesenteric nodes - → Lumbar caval/aortic nodes Canal over the pectinate line - →Internal iliac nodes - →Common iliac nodes - → Lumbar caval/aortic nodes Below the pectinate line: - →Superficial inguinal nodes a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad.  INNERVATION OF ANAL CANAL Over the pectinate line: inferior hypogastric plexus: - Sympathetic for keep the tonus of the internal anal sphincter - Parasympathetic for inhibit the tonus of the internal anal sphincter and Reservados todos los derechos. No se permite la explotación económica ni la transformación de esta obra. Queda permitida la impresión en su totalidad. allows defecation - Afferent sensory fibers: all the anal canal is below the pelvic plane line, so the pain fibers accompany the parasympathetic nerves to S2-S4 Below the pectinate line: somatic fibers from the inferior anal nerve from the pudendal nerve - Sensitive to pain, touch, temperature... a64b0469ff35958ef4ab887a898bd50bdfbbe91a-7885979 Plan Turbo - Eliminar los vídeos + 10 descargas sin publicidad por sólo 0,99€ / mes - Oferta limitada