Download MBBS Anatomy PPT 63 Cecum Appendix Notes

Cecum is the commencement of large

intestine, furnished with taenia coli.

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

Present usually in

the right iliac fossa.

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

divided into

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Infantile type
? Foetal type
? Adult type
? Exaggerated type

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

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Relations
? Anteriorly:

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1. Coils of small intestine.
2. Sometimes part of the greater omentum.
3. And the anterior abdominal wall in the right iliac region.
? Posteriorly:
1. The psoas and the iliacus muscles.

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2. The femoral nerve.
3. The lateral cutaneous nerve of the thigh.
4. The appendix is commonly found behind the cecum.
? Medially:

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The appendix arises from the cecum on its medial side.

Blood Supply

Arteries

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Anterior and posterior cecal arteries from the ileocolic

artery, a branch of the superior mesenteric artery.

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Veins

The veins correspond to the arteries and drain into the

superior mesenteric vein.

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Lymph Drainage

The lymph vessels pass through several mesenteric nodes

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and finally reach the superior mesenteric nodes.

Nerve Supply

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Branches from the sympathetic(T11-L1) and

parasympathetic (vagus) nerves form the superior

mesenteric plexus.

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

? Appendicular Orifice

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A narrow worm-like tubular diverticulum which

arises from the postero-medial wall of the ceacum.

Suspended by a peritoneal fold called

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mesoappendix.

The body of appendix is kinked on itself,hence

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called vermiform appendix.

Devoid of taenia coli,sacculations and appendices

epiploicae.

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Large aggregations of lymphatic tissue-

Abdominal Tonsil

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Average length- 9 cm

Presenting parts:
? Base-attached to the posteromedial wall of
ceacum.

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? Body-narrow,tubular and contains a canal which

opens into ceacum.

? Tip-least vascular and is directed in various

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positions.


According to the orientation of tip, appendix is

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divided into following types:

? Paracolic (11 o' clock)
? Retrocecal (12 o'clock)

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? Splenic (2 o'clock)
? Promonteric (3 o'clock)
? Pelvic type(4 o'clock)
? Mid-inguinal type(6 o'clock)

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Mesoappendix:

Triangular peritoneal fol which invests the entire appendix

Derived from the posterior layer of mesentery of the ileum.

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Appendicular vessels pass with in the free margin of the

mesoappendix.

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Blood Supply
Arteries

The APPENDICULAR artery- branch of the ILEO COLIC artery.

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Veins

The appendicular vein drains into ILEO COLIC vein.

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Lymph Drainage

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

mesoappendix and then eventually into the superior mesenteric

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nodes.
Nerve Supply

The appendix is supplied by the sympathetic and

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parasympathetic (vagus) nerves from the superior

mesenteric plexus.

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Afferent nerve fibers concerned with the conduction of

visceral pain from the appendix accompany the

sympathetic nerves and enter the spinal cord at the level of

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the 10th thoracic segment.

APPENDICITIS
Inflamation of appendix is called appendicitis.It is usually

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manifested by pain,temperature and vomitting ? Murphy's

Syndrome.

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

in the right iliac area due to local peritonitis.
It is associated with tenderness and regidity at

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McBurney's Point-represented by a point at the

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

which extends from umbilicus to Rt. Anterior

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superior iliac spine.


In retroceacal appendicitis patient experiences pain on

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

Rt.Psoas major muscle - Psoas Test.

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Anatomical factors which cause appendicitis are-
? Faecolith in the blind lumen of appendix.
? Supplied by an end artery.
? Presence of hiatus muscularis in the muscular

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coat.

? Presence of numerous lymphatic follicles in the

sub mucous coat.

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The surgical removal of appendix is known as

Appendicectomy.

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If the ceacum adheres to the inferior surface of the

liver when it returns to the abdomen,it wil be

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drawn superiorly as the liver dimnishes in size.As

a result ceacum & appendix remains in the fetal

position.

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

fetuses.

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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

colon.

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In approximately 10% people ceacum has an

abnormal freedom & in unusual cases it may

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herniate in to Rt.inguinal canal.

This condition is clinically significant as it can

lead to Volvulus (twisting)of ceacum.

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Ceacal Volvulus

Mobile Ceacum

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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

is called intussusception.

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Caecum acts as a guide in the operation of

intestinal obstruction:-

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? 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.