The rectum is the lower part of the large intestine extending from the sigmoid colon to the anal canal. It is around 5 inches long and located in the pelvis in front of the sacrum and coccyx. It has two flexures that follow the curves of the sacrum and coccyx. The upper third is covered in peritoneum while the lower third has no peritoneal covering. It is supplied by branches of the inferior mesenteric artery and drains into internal iliac and inferior mesenteric lymph nodes. A thorough understanding of rectal anatomy is important for surgical management of rectal conditions and cancer.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
colon anatomy, anatomy of large intestine, anatomy of large bowel, histology of large intestine, large intestine, histology, colon, appendices epiploica, taenia coli, haustrautions, ilio caecal valve
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
Surgical Anatomy of the Liver : Ηepatectomies - Dimitris P. KorkolisDimitris P. Korkolis
- The liver is the largest gland in the body and has a wide variety of functions
- Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
- It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen)
Function of the liver :
- Secretion of bile & bile salt
- Metabolism of carbohydrate, fat and protein
- Formation of heparin & anticoagulant substances
- Detoxication
- Storage of glycogen and vitamins
- Activation of vita .D
colon anatomy, anatomy of large intestine, anatomy of large bowel, histology of large intestine, large intestine, histology, colon, appendices epiploica, taenia coli, haustrautions, ilio caecal valve
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
Surgical Anatomy of the Liver : Ηepatectomies - Dimitris P. KorkolisDimitris P. Korkolis
- The liver is the largest gland in the body and has a wide variety of functions
- Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
- It is exocrine(bile) & endocrine organ(Albumin , prothrombin & fibrinogen)
Function of the liver :
- Secretion of bile & bile salt
- Metabolism of carbohydrate, fat and protein
- Formation of heparin & anticoagulant substances
- Detoxication
- Storage of glycogen and vitamins
- Activation of vita .D
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. OverviewOverview
Introductions
Location of the rectum
extent of the rectum
Dimensions
Flexures
Peritoneal relations
Visceral relations
Blood supply
Lymphatic drainge
Nerve supply
Clinical aspects
3. A thorough understanding of
anatomy is integral to the
surgical management of problems
of the colon and rectum.
4. RECTUM ANATOMY
The rectum is the lower part
of the alimentary tract
extending from the sigmoid
colon to the anal canal.
Location :
In front of lower three
pieces of sacrum and the
coccyx.
5. Rectum
It is about 5 inches long (12–15 cm).
After surgical mobilization, the
rectum can be stretched to 15–20 cm
in length.
7. THE RECTUM
begins:
Most surgeons consider the
rectosigmoid junction to be at
the level of the sacral
promontory.
Surgeons have traditionally
placed the upper border of the
rectum at the peritoneal
reflection.
Anatomists consider the
rectosigmoid junction to be
located at the level of S3.
S3
rectum
8. THE RECTUM
begins:
Others consider the
rectosigmoid
junction to be
the narrowest
portion of the
large intestine
where the teniae
fuse together to
form a single
anterior tenia.
( where the taeniae
completely
merge).
9. The Rectum
The rectum Structurally
has:
NO taeniae coli,
NO omental appendices,
NO sacculations (haustra of
the colon)..
10. At the rectosigmoid junction, the
three taeniae coli become broad and
fuse together, and the rectum is
totally invested with two complete
muscle layers.
This explains why diverticula do not
form in the rectum.
11. RECTUM
The rectum Ends
at the anorectal
junction (the point
where passing
through the levator
ani muscles):
2-3 cm in front
of and a little
below the
coccyx
at the level of the
anorectal ring
(the level of the
puborectalis sling)
.
12. The anorectal junction
The rectum piercing the
pelvic diaphragm and
becoming continuous with
the anal canal.
13.
14. RECTUM
Its caliber is
similar to that of
the sigmoid colon (
~ 4cm) at its
commencement,
but it is dilated
near its
termination,
forming the rectal
ampulla.
15. The rectal ampulla
The rectal ampulla (or ampulla recti)
is the dilated section of the rectum
where feces are stored until they are
eliminated via the anal canal.
16.
17.
18. Rectal Flexures (Shape(
The rectum is curved
Antero-posteriorly and
laterally:
A. Antero-posterior
flexures :(2 flexures ):
1. Sacral flexure
Follows the curve of
the sacrum and coccyx
1. Perineal flexure /
Anorectal flexure
In the terminal part of
the rectum
19. the lateral flexures must be remembered when one is passing
a sigmoidoscope to avoid causing the patient unnecessary
discomfort.
Upper
flexure
Middle
flexure
Lower flexure
B.Lateral Flexures : 3 flexures
Upper flexure: with convexity to the right.
Middle flexure :Is the most prominent one with convexity to the
left.
Lower flexure : with convexity to the RT.
20. The middle rectal fold
corresponds to the level
of the anterior peritoneal
reflection
The folds are
encountered by the
sigmoidoscope at
• 5–6,
• 8–9,
• and 11–13 cm
from the anal verge.
21. anterior peritoneal reflection
The peritoneal reflection is 7
to 9 cm from the anal verge
in men and 5 to 7.5 cm in
women.
This anterior peritonealized
space is called the pouch of
Douglas, pelvic cul-de-sac,
or rectouterine pouch and
may serve as the site of so-
called drop metastases from
visceral tumors.
22. peritoneal
metastases can
form a mass in the
cul-de-sac (called
Blumer’s shelf )
that can be
detected by a
digital rectal
examination.
23. VALVES OF HOUSTON (transverse folds(
They are lost after full surgical mobilization of the rectum, a maneuver that may
provide approximately 5 cm of additional length to the rectum, greatly facilitating
the surgeon’s ability to fashion an anastomosis deep in the pelvis.
24. VALVES OF HOUSTON
It is thought that these folds serve
to support the weight of the feces
and to prevent excessive distention
of the rectal ampulla.
25.
26. PERITONEAL COVERING
The rectum is a retroperitoneal structure.
the upper third :
completely covered by
peritoneum except for a
small segment posteriorly
where the superior
hemorrhoidal vessels descend
through the mesorectum to
supply the rectum.
the middle part :
front ( ventrally) .
The lower third :
no peritoneal covering .
the rectum
29. Intraperitoneal rectum Injuries
Because of the anatomical and clinical
similarities between the
intraperitoneal rectum and the distal
left colon,
intraperitoneal rectal injuries are
managed like colon injuries, the
vast majority amendable to
primary repair.
TRAUMA Seventh Edition Kenneth L. Mattox
30. extraperitoneal rectum Injuries
The lower third of the rectum is
completely extraperitoneal and makes
exposure and repair of any injuries
difficult.
the cornerstone of extraperitoneal rectal
injuries was based on a triad consisting
of :
fecal diversion,
presacral drainage,
and distal rectal washout.
TRAUMA Seventh Edition Kenneth L. Mattox
31. FASCIA AROUND THE RECTUM
Fascia of DENOVILLIER
Fascia of WALDEYER
32. Fascia of DENOVILLIER
Fascia of
DENONVILLIER-
anterior to the
rectum
(rectoprostatic
fascia) in male.
In female
Denonvilliers
fascia being often
scant and difficult
to identify.
34. .
The lymphatics are contained within the
mesorectum, and total mesorectal
excision adheres to the basic surgical
oncologic principle of removal of the cancer in
continuity with its blood and lymphatic
supplies.
Resection of the rectum by this technique, and
based on a thorough understanding of
anatomy, has been shown to reduce markedly
the incidence of subsequent local recurrence of
rectal cancer.
35. Mesorectum
Mesorectum: The
mesentery of the
rectum, i.e.,
mesorectum, is the
perirectal fatty
lymphovascular
tissue extending the
length of the rectum.
The mesorectum
encases the rectum
as a thick cushion
mainly posteriorly
and laterally.
36. FASCIA AROUND THE RECTUM
The posterior aspect of the rectum is invested
with a thick, closely applied mesorectum.
A thin layer of investing fascia (fascia propria)
coats the mesorectum and represents a distinct
layer from the presacral fascia against which it
lies.
During proctectomy for rectal cancer,
mobilization and dissection of the rectum
proceed between the presacral fascia and
fascia propria..
38. Relations
Posteriorly
3 Bones & Ligaments
Lower ½ of the sacrum
Coccyx
Anococcygeal ligament
3 Muscles
Piriformis
Coccygeus
Levator ani
3 Vessels
Median sacral VS
Superior rectal vs
Lower lateral sacral vs
3 Nerves
Lower 3 the sacral nerves
the sympathetic trunks
Coccygeal nerves
39. :BLOOD SUPPLY
Arteries
Superior rectal (hemorrhoidal)
artery :
Middle rectal artery
From internal iliac artery
Distributed mainly to the
muscular coat.
lnferior rectal artery:
Is a branch of the internal
pudendal artery in the
perineum. It anastomoses
with the middle rectal artery
at the anorectal junction.
40. Superior rectal (hemorrhoidal) artery:
It is Continuation of
inferior mesenteric
artery.
It gives three branches
at3,7,'l 1 O'clock.
Surgical importance :
Mother piles at these sites.
41. :THE RECTUM
Arteries
The median sacral artery:
It sends several very small branches to the
posterior wall of the rectum.
Surgical Anatomy and Technique Lee J. Skandalakis Fourth Edition
44. Venous drainage
Remember:
Anastomoses occur
between:
the superior rectal vein
(portal) and
the middle and inferior
rectal veins (systemic),
constituting a potential
porto-systemic
shunt.
45. Lymph Drainage
Lymphatic vessels and lymph nodes follow
the regional arteries.
Lymphatic channels in the upper and middle
rectum drain superiorly into the inferior
mesenteric lymph nodes.
Lymphatic channels in the lower rectum drain
both:
superiorly into the inferior mesenteric lymph nodes
laterally into the internal iliac lymph nodes.
47. Lymph Drainage
Downward spread of lesions of the
rectum is rare; perhaps only 2 %
may spread downward.
Surgical Anatomy and Technique Lee J. Skandalakis Fourth Edition
48. Nerve Supply
The nerve supply is from the
sympathetic and parasympathetic
nerves from the inferior
hypogastric plexuses.
The rectum is sensitive only to
stretch.
49.
50.
51. sources
Surgical Anatomy and Technique Lee J. Skandalakis
Fourth Edition
TRAUMA Seventh Edition Kenneth L. Mattox
Gray’s Anatomy for Students
Richard S. Snell – Clinical Anatomy by Regions
Last’s Anatomy - Regional and Applied
Frank H. Netter – Atlas of Human Anatomy
In medicine, Blumer's shelf is a finding felt in rectal examination that indicates that a tumor has metastasized to the pouch of Douglas. It is usually a site of metastasis of cancers of the lung, pancreas, and stomach.[1]
Blumer's shelf or peritoneal cul-de-sac, is a shelf palpable on rectal or vaginal examination. It is due to metastatic tumor cells gravitating from an abdominal cancer and growing in the rectovesical or rectouterine pouch.