Differences
Between the Small and Large Intestine
External Differences
External Differences
■■ The
small intestine has no fatty tags attached to its wall. The large intestine has
fatty tags, called the appendices epiploicae.
■■ The
small intestine is mobile( but not the duodenum), whereas the ascending and
descending parts of the colon are fixed.
■■ The
caliber of the full small intestine is smaller than that of the filled large
intestine.
■■ The
small intestine (with the exception of the duodenum) has a mesentery that passes
downward across the midline into the right iliac fossa.
■■ The
longitudinal muscle of the small intestine forms a continuous layer around the
gut. In the large intestine (with the exception of the appendix), the
longitudinal muscle is collected into three bands, the teniae coli
■■ The
wall of the small intestine is smooth, whereas that of the large intestine is
sacculated
Internal Differences
■■ The
mucous membrane of the small intestine has permanent folds, called plicae
circulares, which are absent in the large intestine.
■■ The
mucous membrane of the small intestine has villi, which are absent in the large
intestine.
■■
Aggregations of lymphoid tissue called Peyer’s
patches are found in the mucous membrane of the small intestine; these are
absent in the large intestine.
Liver
Trauma
Because The liver is
a soft organ, it is a friable structure enclosed in a fibrous capsule.
Fractures of the lower ribs or penetrating wounds of the thorax or upper
abdomen are common causes of liver injury because Its close relationship to the lower
ribs must be emphasized.. Blunt traumatic injuries from automobile accidents
are also common, and severe hemorrhage accompanies tears of this organ. Because
anatomic research has shown that the bile ducts, hepatic arteries, and portal
vein are distributed in a segmental manner, appropriate ligation of these
structures allows the surgeon to remove large portions of the liver in patients
with severe traumatic lacerations of the liver or with a liver tumor. (Even large,
localized carcinomatous metastatic tumors have been successfully removed.)
Liver
Biopsy
Liver biopsy is a common diagnostic procedure. And to reduce the size of the
costodiaphragmatic recess and the likelihood of damage to the lung the patient
must holding his or her breath in full
expiration—a needle is inserted through the right 8th or 9th intercostal space
in the midaxillary line. The needle passes through the diaphragm into the
liver, and a small specimen of liver tissue is removed for microscopic examination.
Subphrenic
Spaces
The important subphrenic spaces and their relationship to
the liver are described on page 163. Under normal conditions, these are potential
spaces only, and the peritoneal surfaces are in contact. An abnormal
accumulation of gas or fluid is necessary for separation of the peritoneal
surfaces. The anterior surface of the liver is normally dull on percussion.
Perforation of a gastric ulcer is often accompanied by a loss of liver dullness
caused by the accumulation of gas over the anterior surface of the liver and in
the subphrenic spaces.
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