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`

`TEXTBOOK OF
`
`. astroenterology
`
`VOLUME ONE ‘.
`
`EDITOR
`TADATAKA YAMADA, MD
`
`john G. Searle Professor and Chairman, Department of
`Internal Medicine, Professor of Physiology, Physician—in-Chiej;
`University of Michigan Medical Center, Ann Arbor, Michigan
`
`,3
`
`.
`
`ASSOCIATE EDITORS
`
`ALPERS, MD
`DAVID
`Professor of Medicine, Chief: Gastroenterology Division, Washington University
`School of Medicine, St. Louis, Missouri
`
`CHUNG OWYANG, MD
`Professor of Internal Medicine, Division Chief of Gastroenterology, University
`ofMichigan Medical Center, Ann Arbor, Michigan
`
`DON W. POWELL, MD
`
`The Edward Randall and Edward Randall, fr. Chair in Internal Medicine,
`‘Professor and Chairman ofInternal Medicine, Professor of Physiology and
`Biophysics, The Universiga of Texas Medical Branch Hospitals at Galveston,
`Galveston, Texas
`'
`
`FRED E. SILVERSTEIN, MD
`
`Professor ofMedicine, University of Washington School of Medicine,
`Seattle, Washington
`'
`
`ii?"
`
`1.3. LIPPINCOTT COMPANY
`Philadelphia
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`London
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`Acquisitions Editor: Dean Manke
`Developmental Editor: Richard Winters
`Project Editors: Marian A. Bellus and Melissa McElroy
`Indexer: Maria Coughlin
`Designer: Susan Hess Blaker
`Design Coordinator: Doug Smock
`Production Manager: Caren Erlichman
`Production Coordinator: Kevin P. Johnson
`Competitor: TAPSCO, Inc.
`'
`Printer/Binder: The Courier Book Co./Westford
`
`Copyright © [991, by I. B. Lippincott company. All rights reserved. No part of this book
`may be used «reproduced in any manner whatsoever without written permission except
`for brief quotations embodied in critical articles and reviews. Printed in the United States
`of America. For infoi'r'nation write J. B. Lippincott Company, East Washington Square,
`Philadelphia, Pennsylvania 19105.
`i
`
`6 5 4 3 2 1
`
`Library of Congress Cataloging—in-Publication Data
`
`Textbook of gastroenterology/editor, Tadataka Yamada', associate
`editors, David H. Alpers .
`.
`. [et al,]..
`p.
`cm.
`'
`Includes bibliographical references.
`Includes index.
`ISBN 0-397-51227-9 (vol l).—ISBN 0-397-50973-2 (2 vol set)
`1. Gastroenterology.
`2. Gastrointestinal system—Diseases.
`I. Yamada, Tadataka.
`II. Alpers, David H.
`[DNLM:
`l. Gastrointestinal Diseases. WI 100 T3551]
`RC801.T43
`1991
`616.3'3-—dc20
`DNLM/DLC
`for Library of Congress
`
`,
`
`90—6386
`CIP
`
`The authors and publisher have exerted every effort to ensure that drug selection and dos-
`age set forth in this text are in accord with current recommendations and practice at the
`time of publication. However, in view of ongoing research, changes in government regula—
`tions, and the constant flow of information relating to drug therapy and drug reactions,
`the reader is urged to check the package insert for each drug for any change in indications
`and dosage and for added warnings and precautions. This is particularly important when
`the recommended agent is a new or infrequently employed drug.
`
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`

`Anatomy ofMotor Structures
`
`I 181
`
`the common and troublesome symptoms generally attributed to
`motor dysfunction of the bowel.
`
`DESCRIPTION OF THE COMPONENT
`PARTS OF THE LARGE INTES’I‘INE
`
`ANATOMY OF MOTOR STRUCTURES
`
`Gross Anatomy
`
`COMPONENT PARTS OF
`THE LARGE INTESTINE
`
`The large intestine is often called by the name of one of its com-
`ponent parts, the colon. The large intestine is divided into five
`parts: the appendix, the cecum, the colon, the rectum, and the
`anal canal. These parts are anatomically and physiologically dis-
`tinct. They should be kept in mind as separate structures.
`The colon extends from the iieocolic junction to the rectosig-
`moid junction. It is divided into four regions: the ascending, trans-
`verse, descending, and sigmoid regions. Although the distinctions
`among these regions are somewhat arbitrary, this division is useful
`both physiologically and anatomically. The parts of the large in-
`testine are partly delineated by points or loci. These points are
`the ileocolic junction, the hepatic flexure, the splenic flexure, and
`the rectosigmoid junction. All these parts and loci are shown in
`Figure 10-1.
`
`The cecum is a blind pouch beyond the ileocolic junction. The
`cecum and the appendix have a generous mesentery and are,
`therefore, quite mobile.
`The ascending colon, extending from the ileocolic junction to
`the hepatic fiexute, has no mesentery; the investing peritoneum
`holds it against the adjacent kidney and dorsal muscles. The trans-
`verse colon, extending from the hepatic fiexure to the splenic
`flexure has a broad mesentery so that it generally loops below the
`interiliac line. The descending colon, extending from the splenic
`flexure to the upper aperture of the pelvis, lacks a mesentery so
`that the peritoneum holds it against the kidney and dorsal muscles.
`The sigmoid colon, extending from the pelvic aperture to the rec—
`tosigmoid junction, has a broad mesentery so that it often forms
`a loop that protrudes into the abdomen. The rectum extends from
`the rectosigmoid junction to the anal canal. About 6 to 8 cm above
`the anal canal, the peritoneum is reflected from the rectum to
`adjacent structures so that the distal rectum is extrapetitoneal.
`The anal canal is surrounded by the striated musculature of the
`pelvic floor, including the external anal sphincter.
`
`Structure of the Wall
`of the Large Intestine
`
`'
`
`0
`
`The large intestinal wall, like the rest of the gut, has three major
`layers: the mucosa, the submucosa, and the muscularis propria.
`Each major layer has subdivisions.
`
`“Transverse
`Hepatic
`colon
`FIexure
`
`Splenic
`Flexure
`
`Ascending
`Colon
`
`Descending
`Colon
`
`
`
`Rectosigmoid
`Junction
`
`lleum \
`
`Si moid
`/_ olon
`
`\
`
`FIGURE 10-1. Gross anatomy of the large intestine.
`
`
`
`Anal Canal
`
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