Download MBBS Anatomy PPT 47 Cecum Appendix Notes

Cecum is the commencement of large

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intestine, furnished with taenia coli.

Its a cul-de-sac (blind space).

Present usually in

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the right iliac fossa.

Size: Length-6 cm,Breadth-7.5 cm
Shape: Asymmetric.According to the shape,the cecum is

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divided into

Infantile type
? Foetal type

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? Adult type
? Exaggerated type
q Relations:
? Peritoneal- Covered by peritoneum on all side

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Relations

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? Anteriorly:
1. Coils of small intestine.
2. Sometimes part of the greater omentum.
3. And the anterior abdominal wall in the right iliac region.

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? Posteriorly:
1. The psoas and the iliacus muscles.
2. The femoral nerve.
3. The lateral cutaneous nerve of the thigh.

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4. The appendix is commonly found behind the cecum.
? Medially:

The appendix arises from the cecum on its medial side.

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Blood Supply

Arteries

Anterior and posterior cecal arteries from the ileocolic

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artery, a branch of the superior mesenteric artery.

Veins

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The veins correspond to the arteries and drain into the

superior mesenteric vein.

Lymph Drainage

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The lymph vessels pass through several mesenteric nodes

and finally reach the superior mesenteric nodes.

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Nerve Supply

Branches from the sympathetic(T11-L1) and

parasympathetic (vagus) nerves form the superior

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mesenteric plexus.
q Interior of the cecum
It has two orifices.
? Ileo-ceacal Orifice

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? Appendicular Orifice

A narrow worm-like tubular diverticulum which

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arises from the postero-medial wall of the ceacum.

Suspended by a peritoneal fold called

mesoappendix.

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The body of appendix is kinked on itself,hence

called vermiform appendix.

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Devoid of taenia coli,sacculations and appendices

epiploicae.

Large aggregations of lymphatic tissue-

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Abdominal Tonsil

Average length- 9 cm

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Presenting parts:
? Base-attached to the posteromedial wall of
ceacum.
? Body-narrow,tubular and contains a canal which

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opens into ceacum.

? Tip-least vascular and is directed in various

positions.

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According to the orientation of tip, appendix is

divided into following types:

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? Paracolic (11 o' clock)
? Retrocecal (12 o'clock)
? Splenic (2 o'clock)
? Promonteric (3 o'clock)

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? Pelvic type(4 o'clock)
? Mid-inguinal type(6 o'clock)

Mesoappendix:

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Triangular peritoneal fol which invests the entire appendix

Derived from the posterior layer of mesentery of the ileum.

Appendicular vessels pass with in the free margin of the

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mesoappendix.

Blood Supply
Arteries

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The APPENDICULAR artery- branch of the ILEO COLIC artery.

Veins

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The appendicular vein drains into ILEO COLIC vein.

Lymph Drainage

The lymph vessels drain into one or two nodes lying in the

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mesoappendix and then eventually into the superior mesenteric

nodes.
Nerve Supply

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The appendix is supplied by the sympathetic and

parasympathetic (vagus) nerves from the superior

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mesenteric plexus.

Afferent nerve fibers concerned with the conduction of

visceral pain from the appendix accompany the

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sympathetic nerves and enter the spinal cord at the level of

the 10th thoracic segment.

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APPENDICITIS
Inflamation of appendix is called appendicitis.It is usually

manifested by pain,temperature and vomitting ? Murphy's

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Syndrome.

The pain is often felt first in umbilical region,then settles

in the right iliac area due to local peritonitis.

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It is associated with tenderness and regidity at

McBurney's Point-represented by a point at the

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junction of medial 2/3rd & lateral 1/3rd of a line

which extends from umbilicus to Rt. Anterior

superior iliac spine.

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In retroceacal appendicitis patient experiences pain on

extension of Rt. Hip joint due to tension of the irritated

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Rt.Psoas major muscle - Psoas Test.

Anatomical factors which cause appendicitis are-
? Faecolith in the blind lumen of appendix.

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? Supplied by an end artery.
? Presence of hiatus muscularis in the muscular

coat.

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? Presence of numerous lymphatic follicles in the

sub mucous coat.

The surgical removal of appendix is known as

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Appendicectomy.

If the ceacum adheres to the inferior surface of the

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liver when it returns to the abdomen,it wil be

drawn superiorly as the liver dimnishes in size.As

a result ceacum & appendix remains in the fetal

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position.

Its more common in males & occur in about 6% of

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fetuses.

It may create a problem in the diagnosis of

appendicitis & appendectomy.

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Subhepatic ceacum and Appendix

It results from incomplete fixation of the ascending

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colon.

In approximately 10% people ceacum has an

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abnormal freedom & in unusual cases it may

herniate in to Rt.inguinal canal.

This condition is clinically significant as it can

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lead to Volvulus (twisting)of ceacum.

Ceacal Volvulus

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Mobile Ceacum

Sometimes the terminal part of the ileum is

telescopically invaginated into ceacum and

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ascending colon at the ileo-ceacal junction and

produces intestinal obstruction. This phenomenon

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is called intussusception.


Caecum acts as a guide in the operation of

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intestinal obstruction:-

? If the ceacum is distended,obstruction occur in the

large gut.

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? If the ceacum is empty,the obstruction is of small

gut.