 Salient parts about the small intestine. So this is the supine cadaver. This is the right side of the cadaver This is the left side camera person on the right side towards the leg end We have removed the large intestine. So and the small intestine is being held up by my assistant here The first thing I wanted you to notice is the line of attachment of the small intestinal Misentry line of attachment is oblique the way my finger is tracing So it starts from the upper left quadrant It starts from the transverse versus tip of the transverse process of L2 vertebra here where my probe is pointing and It goes obliquely down and it ends at the right upper sacroiliac joint Which is approximately here. So this is the line of attachment of the small intestinal masonry This is only 45 centimeters in length. It's the root of the masonry and from here Six to seven meters of small intestine come out in a highly coiled fashion and we can see that here in front of us So that brings me to the next point the origin of the small intestine and the termination of the small intestine So for the origin, I will put my finger here This is the deodorant regional junction. And if I lift it up here, you can see the under surface of the deodorant I'm here. This is retro petronial and here it becomes the Gijinum intra petronial So this is the DJ flexure. And if when we dissect deeper, we will see a fibromuscular strand going from here upwards towards the right Rest of the diaphragm, which is known as the suspensory ligament of trites. But that we cannot see in this dissection We can see a small depression here. This is referred to as the paratidinal fossa This paratidinal fossa is the fold of petronium, which has been produced by the retro petronial deodorant coming up into the intra petronial Gijinum And this is a potential site of internal herniation What makes this internal herniation more risky is because on the free margin of the paratidinal fossa is running This vein that we can see here. This is the Inferior miscentric vein accompanied by the inferior miscentric artery The inferior miscentric vein runs up in the free margin of the paratidinal fossa If a loop of intestine is trapped here and we are trying to remove it and we try to cut the fold of petronium We are likely to injure the inferior miscentric vein The artery fossa is holding the cut portion cut end of the terminal ilium which Was communicating with the cecum which has been removed. So this is the region of the iliocecal junction So therefore the duodenal Gijinum flexure is up in the left upper quadrant And the iliocecal junction is in the right lower quadrant So that also tells us that the line of attachment of the miscentric artery is oblique like this Okay, now I will show you the vascular supply of the small intestine So now my assistants as you can see all of them are stretching out the small intestine here And we can see the vascular supply of the Gijinum And the ilium this is the ilium that's the region of the Gijinum because the small intestine is part of the midcut They're all branches of the superior miscentric artery superior miscentric artery is the artery of the midcut The branches there are not one there are literally hundreds of them all of them run in the layers of the miscentric And this is the miscentric They run in the two layers of the miscentric And we can see the two layers which we have to set out here and they learn in the area tissue between the two layers The proximal two fifths are referred to as the Gijinum branches and the terminal three fifths are referred to as the ilium branches The waves accompany the arteries and all of them ran into the Subway miscentric wave which is to the right of the superior miscentric artery So this is the superior miscentric wave and this is the superior miscentric artery We have lymph nodes in the layers of the miscentric and they are respectively referred to as the juxtapital miscentric and superior central central lymph nodes and then we have the superior miscentric nodes So that's about the lymphatic drainage and the blood supply of the small intestine Now i'm going to tell you how to differentiate the Gijinum from the ilium first. Let's take a look at the intestinal wall itself So we are holding up the terminal ilium in front of us and we can see that it is thin It is pale It is relatively avascular This has got an important clinical correlation whenever we are doing intestinal surgery on the ilium Any resection and astromosis? We have to take special precautions because avascular necrosis of the ilium is much more common than the Gijinum In contrast, let us compare with a loop of Gijinum, which I have brought next to the ilium And we can clearly see that the Gijinum is thick It is fleshy It is pink in color and it is more vascular So that's about the intestinal wall itself The next point that we notice is since we are already on the Gijinum side If we hold up the Gijinum like this now my assistant is holding up a loop of the Gijinum to show the miscentry We notice several things number one We notice that the amount of fat inside the miscentry of the Gijinum is very limited On the other hand, we notice that the blood supply which is traveling in the miscentry towards the miscentric surface of the intestine There are only one levels of vascular arcades And arising from the vascular arcades, we have these long vasarecta Which are traveling in the miscentry and they're reaching the miscentric side of the intestine So this is what we notice about the Gijinum and we can clearly see it through the light This is how we actually do during surgery also In contrast, now my assistants have held up a loop of the terminal ilium Straight away we notice that the miscentry is Thickly laden with fat So much so that we can hardly see through it Not only that the fat is also actually encroaching On to the intestinal wall itself And we have split one layer of the miscentry here to show the blood supply inside and we notice that the ilial arteries There are multiple levels of vascular arcades several generations of them two three four generations And from the apex of the arcades We have small vasarecta Which are going to the miscentric side of the ilium and now we are going to hold both of them side by side So in this classical dissection We can clearly see the differences between the Gijinum and the ilium Regarding their vascularity We can see the Gijinum The blood vessels are long There are just one cities of vascular arcades And then we have long vasarecta In contrast Let's take a look at the a segment of the ilium And for that we have turned it slightly and we can see That there are multiple vascular arcades here And small vasarecta and we can see that the ilium miscentry had much more fat So therefore it required much more dissection and some of the fat is also encroaching out to the Wall of the intestine Where the blood vessels enter that is referred to as the miscentric border and the opposite border is referred to as the anti-miscentric border So that's about the Gijinum ilium differences as far as the vascularity is concerned Gijinum ilium Now my assistant is cutting open a segment of the ilium My assistant has opened up a segment of the terminal ilium and we can see straight away after cleaning it up We can see that the mucosal folds are very minimal Or almost none That is why vangenstein has referred The surface of the ilium as Structuralist And if you were to do a low microscopic examination of the submucosa, we might be able to see pair patches But grossly we cannot see any pair patches. So that is what we see in the ilium Now we will open a segment of the gijinum Now we have cut open a segment of the gijinum and straight away we can see That the mucosal folds are dense thick And much more numerous. This is referred to as the valville conventis or the pleike circularis This is to increase the surface area for absorption And this is the one which when we do a berry meal follow through This gives what is known as a feathery appearance to the berry meal A berry meal follow through to show the feathery appearance of the gijinum mucosa Now we are going to hold a gijinum mucosa Side by side with an alial mucosa to show the comparison So up here we can see the gijinum mucosa and down here we can see a segment of the alial mucosa And when we hold them side by side we can see the comparison So this is gijinum versus alium Ilum is referred to as structuralis gijinum is referred to as feathery appearance