1. The document summarizes the anatomy and blood supply of the stomach, small intestine, large intestine, and rectum. 2. The stomach is J-shaped and located in the epigastrium. It receives blood supply from branches of the celiac trunk and superior mesenteric artery. 3. The small intestine extends from the pylorus to the ileocecal junction and consists of the duodenum, jejunum, and ileum. The duodenum receives its blood supply from the gastroduodenal artery while the jejunum and ileum receive branches from the superior mesenteric artery. 4. The large intestine consists of the cecum

1. Zoltan Juhasz, M.D.
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2. I. Stomach (ventriculus, gaster)
J- shaped, intraperitoneal organ (lig. hepatogastricum, lig.
gastrophrencicum, lig. phrencolienale, bursa omentalis)
found mainly in epigastrium
function: food storing-mixing, digestion
parts: cardia, fundus (in left dome of diaphragm), incisura cardiaca,
corpus (body), pylorus (outflow tract; antrum pyloricum canalis
pyloricus), anterior and posterior walls; greater and lesser curvature,
incisura angularis
blood supply:
anastomosis along greater and lesser curvature
lesser curvature: right gastric a.( from proper hepatic a.) --- left gastric a.
(from celiac trunk)
greater curvature: right gastroepiploic a. (from gastroduodenal a.) --- left
gastroepiploic a. (from splenic a.)
fundus: short gastric aa. (from splenic a. ; in gastrolienal lig.)
veins: right and left gastric v. portal vein; short gastric veins, left
gastroepiploic vein splenic vein; right gastroepiploic v. superior
mesenteric v.
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3. lymph drainage:
upper two-third: gastric lymph nodes
upper third of fundus and body: pancreatico-lienal lymph nodes
lower third of body and greater curvature: pyloric lymph nodes,
pancreatico-duodenal lymph nodes
nerve supply:
parasympathetic: vagus nerve (esophageal hiatus; the right branch
supplies the posterior wall, the left branch the anterior wall of the
stomach)
sympathetic: greater splanchnic nerve (T6-T9)
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4. 4

5. 1. esophagus
2. gastric fundus
with air bubble
3. body of stomach
3a. lesser curvature
3b. greater curvature
4. incisura angularis
5. pars pylorica
6. ampulla duodeni
7. descendent part of duodenum
8. jejunum
9. left dome of diaphragm
10. left colic flexure (filled with air)
AP enema X-ray
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6. II. Small intestine (intestinum tenue)
extends from pylorus to ileocecal junction
parts:
duodenum
jejunum
ileum
main function:absorbtion of nutrients
plicae circulares
(circular folds)
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7. 1. Duodenum
the first and shortest segment of small intestine
surround in C-shape the head of pancreas
most of duodenum is attached to the posterior abdominal wall by the
peritoneum, partly retroperitoneal
parts:
superior horizontal part (intraperitoneal, hepatoduodenal lig.; omental/epiploic
foramen of Winslow; at the level of L1)
descendent part (7-10 cm; major duodenal papilla of Vater- m.sphincter Oddi ;
minor duodenal papilla; L1-L3)
inferior horizontal part (6-8 cm; L3)
ascendent part (5 cm; L3 L2; ligament of Treitz= m. suspensorius duodeni)
duoudeno-jejunal flexure (L2)
blood supply:
gastroduodenal a. (from common hepatic a.) superior pancreatico-duodenal a.; inferior
pancreatico- duodenal a. (from superior mesenteric a.) anastomosis between them
venous drainage: superior mesenteric v. and splenic vein
lymph drainage: pancreatico-duodenal,- pyloric, - mesenteric supp., -celiac lymph nodes
nerve suppply: celiac plexus, superior mesenteric plexus (psy.: vagus n., sy.: greater and lesser
splanchnic nerves)
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8. 2. Jejunum and ileum
altogether 6-7 m in length
main part of ileum lies in the right lower quadrant of abdomen, the last part is
in the pelvis
intraperitoneal (mesenterium- root of mesenterium;at the level of L2,
vessels, nerves,lymphatics, fat)
blood supply : branches of superior mesenteric artery: ileal et jejunal aa.;
superior mesenteric v. (with the splenic vein it forms the portal vein)
lymph drainage: mesenteric and ileocolic lymph nodes
nerve supply: vagus n., greater and lesser splanchnic nerves
presynaptic sympathic fibers synape in celiac and inferior mesenteric ganglion
presynaptic parasympathic fibers synapse in myenteric and submucous plexus
visceral afferent sensory fibers- PAIN (distension of intestine wall -- colic:abdominal pain with
spasm)
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9. 9

10. Double contrast barium enema X-ray 10

11. III. Large intestine
1. Cecum; vermiform appendix
a cecum is the first part of large intestine, continuous with the
ascendant colon; ileum ileocecal foramen (valve of Bauhin)
in the right lower quadrant of abdominal cavity, in iliac fossa
cecum is covered with peritoneum
vermiform appendix is a 6-10 cm long blind process, containing
lymphoid tissue; peritoneal coverage: mesoappendix
inflammation of vermiform appendix: appendicitis (McBurney s point:
punctum maximum of pain: the outer and medial third border of a line
between superior anterior iliac spine and umbillicus)
blood supply: ileocolic a. ( branch of superior mesenteric a.) and its
branch: appendicular artery
lymph drainage: nodi lymphatici ileocolic and superior mesenteric
nerve supply: superior mesenteric plexus (sy. and psy. fibers)
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12. Mc Burney s point
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13. 2. Ascendent colon
extends from cecum to right lobe of liver when it turns
left: left colic flexure
only the anterior and lateral part is covered by
peritoneum
blood supply: right colic a., ileocolic a., middle colic a.
(arcade anastomosis)- marginal a.; right colic v.,
ileocolic v. superior mesenteric vein
lymph drainage: paracolic-, epicolic-, ileocolic-,
superior mesenteric lymph nodes
innervation: superior mesenteric plexus
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14. 3.Transverse colon
45 cm in length, right colic flexure left colic flexure
phrenicocolic lig., phrenicolienal lig., gastrocolic lig.
intraperitoneal (transverse mesocolon)
blood supply: middle colic a. , right and left colic arteries
(anastomosis); superior mesenteric vein
lymph drainage: superior mesenteric lymph nodes
innervation: superior mesenteric plexus (sympathetic,
parasympathetic and visceral afferent fibers)
4. Descendent colon
secondarily retroperitoneal (peritoneal coverage anteriorly and
laterally)
left colic flexure left iliac fossa, continuous with sigmoid colon
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15. 4. Sigmoid colon
40 cm in length, S-shaped
extends from iliac fossa to S3 segment, where it joins rectum
15 cm before anus taenias disappear, this is the rectosigmoideal
junction
intraperitoneal- mesosigmoid
blood supply: left colic a. and sigmoid a. (from inferior mesenteric
a.); inferior mesenteric vein
lymph drainage: intermedial colic and superior mesenteric lymph
nodes
nerve supply:
sympathetic: aortic plexus, superior mesenteric plexus
parasympathetic: pelvic splanchnical nerves- inferior hypogastric plexus
a visceral afferent fibers run together with the autonomic fibers
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16. slightly S-shaped
sacral flexure, perineal flexure
anal canal, rectal ampulla
upper third intraperitoneal, middle third
retroperitoneal, lower third infraperitoneal
rectovesical/rectouterine pouch (cavity of
Douglas)
in males the prostate and seminal vesicles, in
females the vagina can be palpated through
the rectum (rectal digital examination) 16

17. blood supply: superior rectal a. (from inferior mesenteric a.),
middle rectal a. (from internal iliac a.), inferior rectal a. (from
internal pudendal a.)- anastomosis
venous drainage: portosystemic anastomosis;v. superior
rectal v. portal vein; middle and inferior rectal v. inferior
vena cava
clinical importance: absorption of medicines from rectum is
more effective as it avoids the liver; rich submucosal venous
plexuses- dilatation and protrusion: haemorrhoidal nodes
lymph drainage: pararectal and sacral lymph nodes
lymph nodes around aorta and IVC
nerve supply: inferior hypogatric plexus/pelvic nn.,
anus: m. sphincter ani internus (smooth muscle) and
externus (striated muscle), m. levator ani (striated)
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