A detailed Presentation on Appendix , Colon and Rectum and Anal canal

1. A
PRESENTATION
ON
APPENDIX
COLON
RECTUM
and
ANAL CANAL (ANUS)

2. APPENDIX
 The appendix is a small thin pouch that is connected to the
beginning of the large intestine and attached to the posteromedial
end of the cecum.
 It is about 5-10cm long.
 It is located at the lower right hand side of the abdomen, close to
the right hip.
 It contains a large amount of lymphoid tissue
 It is located at retrocecal in relationship to ileum and pelvis.
 The position of the appendix can be categorized into seven main
locations depending on the ileum, Cecum and pelvis, but is not
thought to have any vital functions in the human body.

3. APPENDIX Contd….
 The most common position is retrocecal. They may also be
remembered by their relationship to a clock face:
 Pre-ileal – anterior to the terminal ileum – 1 or 2 o’clock.
 Post-ileal – posterior to the terminal ileum – 1 or 2 o’clock.
 Sub-ileal – parallel with the terminal ileum – 3 o’clock.
 Pelvic – descending over the pelvic brim – 5 o’clock.
 Subcecal – below the cecum – 6 o’clock.
 Paracecal – alongside the lateral border of the cecum – 10 o’clock.
 Retrocecal – behind the cecum – 11 o’clock.

4. THE MOST COMMON POSITIONS OF THE APPENDIX

5. BLOODSUPPLY TO THEAPPENDIX
 Arterial supply is
from the
appendicular artery
(derived from the
ileocolic artery, a
branch of the
superior mesenteric
artery) and venous
drainage is via the
corresponding
appendicular vein.
Both are contained
within the
mesoappendix.

6. Diseases of the Appendix (Appendicitis)
• Appendicitis usually happens when something blocks the entrance of
the pouch usually a small hard pieces of feces blocks the entrance of
the pouch. Thereby causing bacteria from the guts to start multiplying
in the appendix causing it to be filled up with pus and swell.
• Appendicitis starts in the middle of the stomach it may come and go.
Within hours the pains travels to the lower right hand side of the of the
abdominal region where the appendix lies and becomes constant and
severe. Pressure on the area, coughing or walking might end up
making the pains worse.

7. Signsand symptoms
 Loss of appetite, feeling sick, nausea, constipation, diarrhea.
Treatment
 Surgery: One can actually live without appendix as its function is
unknown. Appendicitis is a surgical emergency and the appendix
must be removed immediately if not it can continue to swell and
eventually bursts releasing it contents into the abdomen. This is
very dangerous as the bacteria can cause infections in the lining of
the abdomen (peritonitis) and the blood septicemia. one can live
without appendix with no related problems as it does not really

8. Appendicitis cont'd
 Appendicitis depends on age. In the young, it is mostly due to
an increase in lymphoid tissue size, which occludes the lumen.
From 30 years old onwards, it is more likely to be blocked due
to a faecolith.

9. The anatomyand physiologyof the colon
 THE COLON (LARGE INTESTINE)
The Colon is also known as (Large Intestine).
• It is the distal part of the gastrointestinal tract.
• Extending from the cecum to the anal canal.
• The colon receives digested food from the small intestine from
which it absorbs water and electrolytes to form feces.
• It is about 150cm long and surrounds the small intestine in a square
and question mark shape and with the tail of the question mark
ending at the anal canal.
• It looks likes a semi-flat segmented tube that lays loosely around the

10. The colon (Large intestine)
 The colon (large intestine) is the distal part of the gastrointestinal
tract.
 Extending from the cecum to the anal canal.
 It is about 150cm long and surrounds the small intestine in a
square and question mark shape with the ending of a question
mark at the anal canal.
 It receives digested food from the small intestine from which its
absorbs water and electrolytes to form feces.
 It looks like a semi-flat segmented tube that lays loosely around
the edges of the abdominal cavity.

11. ANATOMICAL STRUCTURES OF THE COLON
Attached to the surface
of the large intestine
are Omental
appendices – small
pouches of
peritoneum, filled with
fat.
Running longitudinally
along the surface of
the large bowel are
three strips of muscle,
known as the Teniae

12. Anatomical position of the colon
The colon is divided into 4 parts. Ascending
Colon, Transverse, colon, Descending colon and
Sigmoid colon.
Ascending Colon: This begins from the retroperitoneal
structure which ascends superiorly from the cecum.
When it meets the right lobe of the liver, it turns 90°
to move horizontally. This turn is known as Right
colic flexure or hepatic flexures and marks the start
of transverse colon.
Anteriorly: Small intestine and anterior

13. ANATOMICAL POSITIONCONTD…
DescendingColon: After the splenic flexure the colon moves inferiorly towards
the pelvis and this gives it the name descending colon. When it begins to turn
medially it becomes Sigmoid colon.
 Anteriorly: Left kidney, small intestine, anterior abdominal wall.
 Posteriorly: Left kidney.
Sigmoidcolon: It extends from the descending colon medically and gives it an S-
shape. It is 50cm long.
 Located in the left quadrant of the abdomen, extending from the left iliac
fossa. It is attached to the posterior pelvic walk by the sigmoid meso-colon.
And this journey gives the sigmoid colon an the S-shape.
 Anteriorly: Urinary bladder and uterus, (for female).
 Posteriorly: the rectum, ileum, sacrum
FUNCTIONOF THE COLON
 It removes water and some nutrients and electrolytes from partially
digested food.
 It removes waste materials and store them in rectum.

14. PHYSIOLOGY OF THE COLON
Approximately 500
millimeters of food
passes through the
colon daily. The colon
function is to dehydrate
what’s left of the food
that has been absorbed
from small intestine
and form it into stool.
It does this by slowly
absorbing water and
electrolytes as its

15. BLOOD SUPPLY TO THE COLON
Blood supply to the colon is through Superior Mesenteric
Artery, and Inferior Mesenteric artery.
The ascending colon receives arterial supply from two
branches of the superior mesenteric artery; the ileocolic and
right colic arteries.
Transverse colon receive blood from both Superior and
Inferior Mesenteric Artery.
The descending colon is supplied by a single branch of the
inferior mesenteric artery; the left colic artery. The sigmoid
colon receives arterial supply via the sigmoid arteries
(branches of the inferior mesenteric artery.
NUTRITIONALMANAGEMENTOF COLITIS
LOW RESIDUE DIET
Cereals and grains (rice, cornflakes,
Vegetable and fruits (vegetables, tomatoes, potatoes, carrots,
cucumber spinach, lettuce, green leaf etc).
DISEASE OF THE COLON
COLITIS: This is an
inflammation of the
inner lining if the
colon due to
infections that attack
the bowl. This could
be as a result of
radiation of therapy
for prostrate or rectal
cancer.
Causes
Rectal bleeding,

16. ANATOMY OF THE RECTUM
It is the most distal end of the colon and continues
from the sigmoid colon and ends in the Anal Canal
(Anus). Its position differs in sexes.
It has two flexures Sacral flexures and Anorectal
flexures with both contributing during feces
contribution (defecation)
Anteriorly:
Male: prostrate, seminal vesicle, bladder, ileum
Female: Vagina, cervix, sigmoid colon.
Posteriorly: Sacrum, coccyx, levetirani, sacral

17. Bloodsupply
The rectum receives arterial blood supply through three main
arteries:
 Superior rectal artery – terminal continuation of the inferior
mesenteric artery.
 Middle rectal artery – branch of the internal iliac artery.
 Inferior rectal artery – branch of the internal pudenda artery.
Venous drainage: This is through the corresponding superior, middle
and inferior rectal veins. The superior rectal vein empties into the
portal venous system, while the middle and inferior rectal veins empty
into the systemic venous system. Anastomoses (the surgical
connections between two vessels where portal and systemic veins are
located in the wall of anal canal, making this a site of porto-caval
anastomosis.

18. Anal Fissure
An anal fissure: is a
split or tear in the
lining of the anus that
occurs after trauma.
This can happen as a
result of a hard stool or
even diarrhea.
 An anal fissure
causes bleeding and
intense burning pain
after bowel
movements. The

19. Anal canal (anus)
 This is the final segment of the GIT.
 It is located within the anal triangle of the perineum
 It is 4cm in length.
 It continues from the rectum
 Its is compile by internal and external sphincters.
 At the junction between the rectum and anus forms the muscular ring
known as Anorectal sphincters.
Anteriorly: The position differs in sexes.
 Male: Urethra, Bulb of the penis.
 Females: urogenital diaphragm, vagina.
Posteriorly: Sacrum and coccyx.
FUNCTION
 It is important for the defecation and maintaining fecal continence.

20. Diseases of the ANALCANAL
Hemorrhoids: This is also known
as Pile. This occurs when there is
any sort of straining that increases
pressure on the belly or lower
extremities this can cause anal and
rectal veins to become swollen and
inflamed there by causing
hemorrhoids. It can be Internal or
External hemorrhoids.
 This swollen of the veins
(varicose veins) maybe inside

21. HEMORRHOIDS
• Internal hemorrhoids: Internal hemorrhoids are
normal blood vessels that line the inside of the
anal opening. We are born with them. They are
thought to be the fine-tuning mechanism that
allows us to contain gas and avoid passing it until
we it is socially acceptable. When internal
hemorrhoids become enlarged as a result of
straining or pregnancy, they may become irritated
and start to bleed.
• External hemorrhoids are veins that lie just
under the skin on the outside of the anus. Usually,
they do not cause any symptoms. Occasionally, a

22. REFERENCES
• Rare paediatric case of agenesis of the vermiform appendix, ileal duplication and
sickle cell disease. Nadia Laezza et al., Case Rep, 2022
• ABC of General Surgery in Children: Acute abdominal pains in Children and Adult.
Mark Davenport, The BMJ, 1996.
• Prognostic value of chromogranin A in patients with GET/NEN in the pancreas and
the small intestine. Małgorzata Fuksiewicz et al., Endocrine Connections, 2018.
• Postoperative Outcomes of Screen-Detected vs Non–Screen-Detected Colorectal
Cancer in the Netherlands. Michael P. M. de Neree tot Babberich et al., JAMA
Surgery, 2018.
• Chemoradiotherapy and Local Excision for Organ Preservation in Early Rectal
Cancer—The End of the Beginning? Julio Garcia-Aguilar, JAMA Surgery, 2019.
• Highlights Journal of American Medical Association, 2018.
• Association of Mechanical Bowel Preparation and Oral Antibiotics Before Elective
Colorectal Surgery With Surgical Site Infection: A Network Meta-analysis James W. T.
Toh et al., JAMA Network Open, 2018.

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