Kálmán M: Morphology and - PowerPoint Presentation

Slide1

Kálmán M:Morphology and histology of the large intestine and rectum

To

the

lectures

for

EM 1-8 and 9-17

on

March

21 and 22, 2019.

Mainly

the

parts

not

emphasized

in

the

textbook

.

The main points

:

The

rectum

is

not

’

rectus

’ i.e.

straight

,

but

S-shaped

,

the

opening

directed

posteriorly

rather

than

downward

!

The

lower

curvature

contacts

the

prostate

or

the

vaginal

fornix

.

The

anal

canal

has 3

parts

intestinal

(

columnar

:

columnae

and

sinuses

) –

intestinal

epithalium

below

it

:

the

pectinate

line –

epi-ectodermal

border

hemorrhoidal

(

venous

plexus

)

stratified

squamous

epithelium

.

below

it

:

white

line, and a

shellow

groove

(

note

:

at

the

border

of

the

2

subdivisions

of

ext

.

sphinter

,

see

later

)

cutaneous

keratinized

stratified

squamous

epithelium

The

anal

canal

is

below

the

floor

of

the

pelvis

(

not

yet

lectured

)

The

external

voluntary

sphincter

onsists

of 3

parts

:

deep

,

supeficial

and

subcutaneous

.

Tha

last

one

is most

important

.

The

longitud

.

smooth

has

tendon-like

elongations

,

which

form

connective

tissue

slings

(

conjoint

fibromuscular

layer

)

around

the

fascicles

of

the

subcutaneous

ext

.

sphincter

)

The

territories

of

arteries

correspond

to

the

developmental

origins

:

superior

rectal

(most part) –

hindgut

derivative

middle

rectal

(

small

,

approx

.

the

sinuses

) -

cloacal

derivative

inferior

rectal

-

proctodeum

derivative

,

ectodermal

,

below

the

pectinate

line

.

The Riolan arcades

The

term

‚

small

’

or

‚

first

’

Riolan

arch

(

the

anastomosis

between

the

sup

. and

inf

.

Pancreaticoduodenal

arteries

is

in

use

actually

only

in

our

institute

;

it

is

not

applied

in

the

textbooks

.

The

mame

‚

arch

of

Riolan

’ is most

probably

incorrectly

applied

on

the

marginal

artery

;

it

is

the

anastomosis

–

or

arch

– of

Drummond

.

Which

artery

was

described

by

Riolan

it

is

already

not

clear

; most

probably

it

was

the

so-called

meandering

mesenteric

artery

,

which

also

interconnects

the

middle

and

left

colic

arteries

but

in

a more

proximal

and

sinuous

line.

For

literature

,

see

the

next

page

.

Note

:

these

and

similar

names

of

authors

(

eponymes

)

are

not

to

be

learned

by

students

;

we

use

them

only

as

a

homage

to

the

elders

.

Papers

helping

clarify

thr

‚

Riolan

’

question

.

Only

for

enthusianistic

volunteers

!

Note

:

the

first

one

was

written

by

dr. Ágnes Nemeskéri and

her

co-workers

from

our

institute

.

Szuák

, András; Halász, Vanda; Gáti, Endre; Harsányi, László; Nemeskéri, Ágnes (2016)

First

Report

on

Arterial

Anastomosis

Between

Transverse

Pancreatic

and

Left

Colic

Arteries

.

Case

Studies

Journal

Vol

5,

Issue

2,

Page

1

Lange, J.F.,

Komen

, N.,

Akkerman

, G.,

Nout

, E.,

Horstmanshoff

, H.,

Schlesinger

, F.,

Bonjer

, J.,

Kleinrensink

, G.J., 2007.

Riolan’s

arch

:

confusing

,

misnomer

, and

obsolete

. A

literature

survey

of

the

connection

(s)

between

the

superior

and

inferior

mesenteric

arteries

. The American Journal of

Surgery

. 193, 742-748.

Walter, T.G., 2009.

Mesenteric

Vasculature

and

Collateral

Pathways

.

Semin

.

Intervent

.

Radiol

. 26(3), 167-174.

Fisher

Df

,

Fry

WJ.

Collateral

Mesenteric

Circulation

"

Surgery

,

Gyencology

and

Obstetrics

. 1987, 164(5):487-492

Gourley

EJ, 

Gering

SA. "The

Meandering

Mesenteric

Artery

: A

Historic

Review

and

Surgical

Implications

."

Disease

of

the

Colon &

Rectum

.

Vol

48:5 (2005) pp

996-1000 (

the

figure

is

taken

from

this

paper

).

Douard

R

,

Chevallier

JM

,

Delmas

V

,

Cugnenc

PH

Clinical

interest of

digestive

arterial

trunk

anastomoses

.

Surg

Radiol

Anat

.

2006

Jun

;28(3):219-27.