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Surgical intervention for abdominal pain after HCT is a rare event but is indicated for intestinal perforation, acute cholecystitis, drainage of abscesses, appendicitis, and in some patients with intestinal or biliary obstruction, typhlitis, and dissecting hematomas. The first question to answer is whether a patient with abdominal pain needs urgent surgery. Fortunately, these disorders are far less common than intestinal pseudo-obstruction, narcotic bowel syndrome, acute GVHD, liver pain related to SOS, and hemorrhagic cystitis-causes of severe pain to be sure, but not imminent death. septicum, adenovirus enteritis, visceral VZV infection, Aspergillus vasculitis), gallbladder necrosis, and bacterial liver abscess. The illnesses that may be rapidly fatal include intestinal perforation, some infections (e.g., typhlitis caused by C. This sphincter is composed of skeletal muscle and is under voluntary control.Mark Feldman MD, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 2021 Abdominal PainĪbdominal pain may be an indicator of a rapidly progressive, fatal illness or an illness with a benign natural history that requires only conservative management ( Table 36.4). There is an external anal sphincter at the inferior end of the anal canal. This sphincter is under involuntary control. The smooth muscle layer is thick and forms the internal anal sphincter at the superior end of the anal canal. The mucosa of the rectum is folded to form longitudinal anal columns. The last 2 to 3 cm of the digestive tract is the anal canal, which continues from the rectum and opens to the outside at the anus. The rectum ends about 5 cm below the tip of the coccyx, at the beginning of the anal canal. It follows the curvature of the sacrum and is firmly attached to it by connective tissue. The rectum continues from the sigmoid colon to the anal canal and has a thick muscular layer. Functions of the large intestine include the absorption of water and electrolytes and the elimination of feces. Chemical digestion is completed in the small intestine before the chyme reaches the large intestine. Unlike the small intestine, the large intestine produces no digestive enzymes. Epiploic appendages, pieces of fat-filled connective tissue, are attached to the outer surface of the colon.
Complete anatomy of the irritated liver series#
Contraction of the teniae coli exerts pressure on the wall and creates a series of pouches, called haustra, along the colon. The longitudinal muscle is limited to three distinct bands, called teniae coli, that run the entire length of the colon. The longitudinal muscle layer, although present, is incomplete. The mucosa has a large number of goblet cells but does not have any villi. The wall of the large intestine has the same types of tissue that are found in other parts of the digestive tract but there are some distinguishing characteristics. The large intestine consists of the colon, rectum, and anal canal. It begins at the ileocecal junction, where the ileum enters the large intestine, and ends at the anus. The large intestine is larger in diameter than the small intestine. This is a direct reflex action, thus the greater the amount of chyme, the greater the secretion. This is largely a local reflex action in response to chemical and mechanical irritation from the chyme and in response to distention of the intestinal wall. The most important factor for regulating secretions in the small intestine is the presence of chyme. Endocrine cells secrete cholecystokinin and secretin. The absorptive surface area of the small intestine is increased by plicae circulares, villi, and microvilli.Įxocrine cells in the mucosa of the small intestine secrete mucus, peptidase, sucrase, maltase, lactase, lipase, and enterokinase. The small intestine follows the general structure of the digestive tract in that the wall has a mucosa with simple columnar epithelium, submucosa, smooth muscle with inner circular and outer longitudinal layers, and serosa. The small intestine is divided into the duodenum, jejunum, and ileum. The liver, gallbladder, and pancreas are accessory organs of the digestive system that are closely associated with the small intestine. The small intestine finishes the process of digestion, absorbs the nutrients, and passes the residue on to the large intestine. The small intestine extends from the pyloric sphincter to the ileocecal valve, where it empties into the large intestine.
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Acknowledgements Small & Large Intestine Small Intestine