An Abnormality At The Hepatic Flexure
A 92 year old woman presented to the emergency department after collapsing at home. She recalled standing from her chair, feeling lightheaded, and then collapsing. She had felt generally weak for more than a year, with weight loss of 56 lb but no change in bowel habit, dysphagia, or gastrointestinal bleeding. Her medical history included hypertension, hypothyroidism, and anaemia . Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer.
On examination she appeared cachectic with evidence of conjunctival pallor. Her blood pressure was 117/54 mm Hg when lying and 52/31 mm Hg when standing. No masses were palpable on abdominal examination.
Fig 1 Axial computed tomogram of the abdomen
Splenic Flexure And The Descending Colon
The splenic flexure lies at a higher level compared with the hepatic flexure . It is held on to the diaphragm by a peritoneal fold, the phrenicocolic ligament on which the spleen sits. It turns downwards as the descending colon, which, like the ascending colon, is retroperitoneal. The descending colon lies on the posterior abdominal wall muscles and is closely related to the left ureter. Close relationship of the splenic flexure to the spleen and the tail of the pancreas are taken care of while performing a left hemicolectomy.
Joseph C. Glennon V.M.D., Dip. A.C.V.S., in, 2004
What Happens At The Hepatic Flexure Of The Colon
4/5intestineintestinecoloncolonright colic flexurecolonflexureanswered comprehensively
The right colic flexure or hepatic flexure is the sharp bend between the ascending colon and the transverse colon. The hepatic flexure lies in the right upper quadrant of the human abdomen. It receives blood supply from the superior mesenteric artery.
what does the splenic flexure do? The right colic or hepatic flexure separates the ascending and transverse colon, and the left colic or splenic flexure separates the transverse and descending colon. In dogs and cats, the large intestine contributes 20% to 25% of the total intestinal length.
People also ask, what is the role of the ascending colon?
The role of the ascending colon is to absorb the remaining water and other key nutrients from the indigestible material, solidifying it to form stool. The descending colon stores feces that will eventually be emptied into the rectum.
Is the hepatic flexure part of the large intestine?
The large intestine includes the cecum, colon, and rectum. Upon entering the colon, the food residue first travels up the ascending colon on the right side of the abdomen. At the inferior surface of the liver, the colon bends to form the right colic flexure and becomes the transverse colon.
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Subgroup Analyses For Os And Css
Subgroup analyses for OS and CSS were performed in prespecified subgroups using forest plots. The prespecified stratification factor was whether PTR was performed.
For the UHFLM group, the forest plot showed that there were no statistical differences in the patients of other race subgroup for OS when the efficacy of PTR to non-PTR was compared there were no statistical differences in the patients with other race subgroup for CSS. Other subgroups showed significant statistical differences for OS and CSS .
Forest plot for UHFLM patients in the subgroup analysis of OS and CSS . Abbreviation: UHFLM, unresectable hepatic flexure cancer liver metastasis MHI, median household income
For the UTCLM group, the forest plot showed that there were no statistical differences in the patients of other race subgroup for OS when the efficacy of PTR to non-PTR was compared. Other subgroups showed significant statistical differences for OS and CSS .
Forest plot for UTCLM patients in the subgroup analysis of OS and CSS . Abbreviation: UTCLM, unresectable transverse colon cancer liver metastasis MHI, median household income
Forest plot for USFLM patients in the subgroup analysis of OS and CSS . Abbreviation: USFLM, unresectable splenic flexure cancer liver metastasis MHI, median household income
Surgery For Colorectal Cancer
Most people with colorectal cancer will have surgery. The type of surgery you have depends mainly on the stage of the cancer, the size and location of the tumour and how much of the colon or both need to be removed.
Surgery may be done for different reasons. You may have surgery to:
- completely remove the tumour and nearby lymph nodes
- completely remove cancer that has spread to other parts of the body, such as the pelvis, liver or lung
- remove as much of the tumour as possible before other treatments
- reduce pain or ease symptoms
The following types of surgery are used to treat colorectal cancer. You may also have other treatments before or after surgery.
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Bowel Cancer Hepatic Flexure
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Polyps And Colorectal Cancer
Between 70 and 90 percent of colorectal cancers arise from adenomatous polyps, and 10 to 30 percent arise from sessile adenomas. The larger the polyp, the greater the potential for malignancy. Diminutive polyps have a negligible malignant potential. Polyps with a diameter of 5 to 10 mm are considered small, whereas polyps greater than 10 mm in diameter are considered large. Polyps larger than 2 cm in diameter have a 50 percent chance of becoming malignant over time.6
Polyps may be hyperplastic or adenomatous. From 15 to 30 percent of persons in the U.S. population ultimately develop polyps. About 15 percent of these polyps are hyperplastic and have no malignant potential. Hyperplastic polyps are usually diminutive or small and cannot be identified without biopsy and histologic examination.6
Among adenomatous polyps, those with a tubular histologic pattern are the least likely to become malignant .10 They are also the most common adenomatous polyps . Adenomatous polyps with this pattern have the highest potential for malignancy. Tubulovillous polyps constitute 12 percent of adenomatous polyps and have an intermediate malignant potential.6,10
*The overall weighted malignant potential for adenomatous polyps is 10.5 percent.
Sessile adenomas occur particularly in patients with hereditary nonpolyposis colon cancer. These adenomas account for 20 to 25 percent of the 2.5 to 5 percent lifetime risk of colorectal cancer.12
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Anatomy Of Colon And Rectum
The right colon consists of the cecum, ascending colon, hepatic flexure and the right half of the transverse colon. The left colon consists of the left half of the transverse colon, splenic flexure, descending colon, and sigmoid. See Figure 1.
What Affects The Blood Flow At Your Splenic Flexure
Injuries to your colon. A serious injury near your splenic flexure could damage your colon and affect blood flow in the area.
Cancer. A tumor growing in or near your splenic flexure can affect the nearby blood vessels and slow or block blood flow. Colon cancer can be more difficult to treat or operate on if it is near the splenic flexure.
Surgery. Surgeons have to be especially careful when operating near the splenic flexure for many reasons, but the most important one is that many blood vessels are found in the area.
Vascular disease. Vascular disease affects the blood flow in your blood vessels. There are many types and causes of vascular disease.
If you’re experiencing severe pain in your upper left abdomen, you may have ischemia in your colon. Treatments for ischemic colitis depend on what caused it. They may also include surgery.
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Staging Of Colorectal Cancer And Survival
Cancer has metastasized to liver, bone or lung.
Information from Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997 112:594642 , and Bresalier RS, Kim YS. Malignant neoplasms of the large intestine In: Feldman M, Sleisenger MH, Scharschmidt BF, eds. Sleisinger & Fordtran’s Gastrointestinal and liver disease pathophysiology, diagnosis, management. 6th ed. Philadelphia: Saunders, 1998.
On occasion, Roman numerals I through IV are used in colorectal cancer staging. These numerals correspond with Dukes classes A through D.
The TNM staging system is more detailed than the Dukes system. This system is most useful for surgical purposes, such as providing guidelines on the extent of resection. The Dukes system and corresponding TNM classifications are presented in Table 3.6
T = tumor N = node M = metastasis TIS = carcinoma in situ T1 = tumor invades submucosa T2 = tumor invades muscularis propria T3 = tumor invades through muscularis propria T4 = tumor invades serosa, nodes and adjacent organs N0 = negative lymph nodes at surgery N1 = one to three positive nodes N2 = more than three positive nodes N3 = positive nodes on vascular trunk M0 = no distant metastases M1 = distant metastases.
*On occasion, colorectal cancer is staged using roman numerals I through IV, which correspond with Dukes stages A through D.
What Is Hepatic Flexure
The hepatic flexure, also known as the right colic flexure, is found in the digestive system of the human body and creates the bend in the colon that connects the ascending colon and the transverse colon. The name of this structure is influenced by its proximity to the liver the word hepatic comes from hpar, which means “liver” in Greek. A flexure is a bend or a fold.
The ascending colon lies on one side of the hepatic flexure, near the right portion of the liver and the gallbladder. The ascending colon begins at the cecum, a pouch found on the colon, also known as the large intestine. From the cecum, it travels throughout the right side of the abdomen, eventually connecting to the part of the large intestine known as the transverse colon.
The transverse portion of the colon is the longest section of the large intestine. This is also the colon segment that is capable of the most movement. It crosses the abdomen, traveling to the left side and ending near the spleen. The transverse colon also attaches to the border of the pancreas.
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Update On Colorectal Cancer
DAVID R. RUDY, M.D., M.P.H., and MICHAEL J. ZDON, M.D., Finch University of Health Sciences/Chicago Medical School, North Chicago, Illinois
Am Fam Physician. 2000 Mar 15 61:1759-1770.
See related patient information handout on screening for colorectal cancer, prepared by Courtenay Brooks, a Georgetown medical editing clerk.
An estimated 129,400 new cases of colorectal cancer occurred in the United States during 1999. The lifetime risk of developing this cancer is 2.5 to 5 percent in the general population but two to three times higher in persons who have a first-degree relative with colon cancer or an adenomatous polyp. Between 70 and 90 percent of colorectal cancers arise from adenomatous polyps, whereas only 10 to 30 percent arise from sessile adenomas. Tumors or polyps that develop proximal to the splenic flexure carry a poorer prognosis than those that arise more distally, in part because of delayed diagnosis secondary to later development of symptoms. The Dukes system is the classic staging method for colorectal cancer the TNM staging system is more detailed and therefore more useful for surgical purposes. Although screening guidelines vary, most agree that colorectal cancer screening should begin at 50 years of age in patients without a personal or family history of colorectal cancer.
Where Is The Splenic Flexure
A “flexure” is a place where the colon bends. Your colon has two flexures: one on the right side and one on the left. The splenic flexure is called that because it’s near your spleen, but sometimes it’s called the left colic flexure because it’s on the left side of your body.
Your small intestine meets your colon in your lower right abdomen. Food is transformed into stool as it travels through the colon. It first travels up through the ascending colon to your upper right abdomen. Then, it crosses your abdomen to the left side of your body through the transverse colon. Finally, it heads back down toward your anus in the descending colon.
The splenic flexure is the bend where the transverse colon and descending colon meet in the upper left part of your abdomen. It is the highest point your colon reaches in your body.
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Abdominal And Retroperitoneal Inflammation And Infection
In general, the proper interpretation of gallium images in the abdomen hinges on the differentiation of physiologic activity from abnormal accumulations of the radiopharmaceutical. A common problem in image interpretation in the abdomen is the presence of gallium in the bowel, which may mimic lesions or mask disease. Bowel activity is particularly prominent in the colon and may be diffuse or focal. Frequently, activity is seen in the regions of the cecum, hepatic and splenic flexures, and rectosigmoid. These accumulations may appear as early as a few hours after injection. The progress of excreted gallium through the colon over time may provide the best evidence of physiologic activity, whereas persistence of gallium in a given area of the abdomen should be viewed as abnormal.
Abscesses in the retroperitoneum are frequently related to associated renal infection. Persistence of more than faint renal activity after 24 hours, progressively increasing activity, and unilateral discrepancy in gallium activity in the kidneys should be considered abnormal. However, abnormally increased activity in one or both kidneys can occur in nonspecific pathologic and physiologic states and may therefore present a difficult problem of differential diagnosis. The differential includes urinary obstruction, nephritis, acute tubular necrosis, diffuse infiltrative neoplasm, vasculitis, parenteral iron injections, blood transfusions, and perirenal inflammatory disease.
In , 2013
Why Is It Called Hepatic Flexure
right colic flexurehepatic flexurehepatic flexure
. Keeping this in consideration, what does hepatic flexure mean?
Medical Definition of hepatic flexure: the right-angle bend in the colon on the right side of the body near the liver that marks the junction of the ascending colon and the transverse colon. called also right colic flexure.
Secondly, why is the left colic flexure higher than the right? Left colic flexure is the bend in the large intestine in the left upper quadrant of the abdomen as the transverse colon continues as the descending colon. The phrenicocolic ligament attaches the splenic flexure to the left hemidiaphragm. It lies more cranial than the right colic flexure.
Additionally, is the hepatic flexure part of the ascending colon?
The ascending colon is the beginning part of the colon. It is usually located on the right side of the body, extending from the cecum upward. At the top of the ascending colon, the colon abruptly bends to the left, forming the right colic flexure .
What is a flexure in anatomy?
2 : an anatomical turn, bend, or fold especially : one of three sharp bends of the anterior part of the primary axis of the vertebrate embryo that serve to establish the relationship of the parts of the developing brain see cephalic flexure, cervical flexure, hepatic flexure, pontine flexure, sigmoid flexure, splenic
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What Is Hepatic Flexure Syndrome
Q:What is hepatic flexure syndrome?
A:The hepatic flexure, also known as the right colic flexure, is found in the digestive system of the human body. It is near the liver. Hepatic flexure syndrome is a common medical issue and it causes a variety of symptoms. The common hepatic flexure syndrome symptoms are abdominal discomfort and gas pains.
CausesAnything you eat with a lot of gas could result in hepatic flexure syndrome. Foods: Foods with a lot of fiber which cannot be fully broken down by the digestive system like beans, legumes, oatmeal, wheat, and broccoli. Beverages: If you drink a lot of alcohol, milk soda, or any carbonated drink, a lot of gas will build up near your liver and cause a great pain.
Symptoms Pain & Discomfort: Your upper abdominal area near the liver will feel great pain and discomfort. You should not try to bend or twist your body too much or it may become worse. Bloating: Your gut will bloat as more gas built up in your abdominal region. Many people may mistake it for being fat, which is not.
TreatmentsYou need to bring relief to your digestive system. Do not fill it with too much gas. Better Diet: Eat foods that do not cause gas like whole grain bread and leafy greens. Surgery: If your condition is too severe, you may need to get surgery.
Please go to your doctor for more advice.
Keywords: hepatic flexure
Cancer In Hepatic Flexure
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