abdomen review 2011-12 e-learning

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Abdomen:Abdomen:

ReviewReview



Surface AnatomySurface Anatomy

9 r egions classif ication

Subcostal plane:

lowest costal mar gin,

10 cc, L3

Transtubercular plane:

iliac tubercles

what vertebral level?

Midclavicular planes:

mid clavicle

¾

mid inguinal lig.



4 Regions classif ication

Transumbilical plane

IV disc L3-L4

Midsagittal line

symphesis menti

¾

symphesis pubis



Layer s of Abdominal WallLayer s of Abdominal Wall

1. Skin

2. Superf icial fascia:

camper¶s

scar pa¶s

3. Deep muscle fascia

4. Muscles (3 lat. 2 ant. &

??post.)

5. Transver salis fascia

6. Extraper itoneal fat



Layer s of Abdominal WallLayer s of Abdominal Wall



Inguinal CanalInguinal Canal

Location?

Openings?

Walls?

Contents?



Anatomy of Inguinal CanalAnatomy of Inguinal Canal

M - muscles

A - aponeur oses

L - ligamentsT - transver salis/tendon



Sper matic Cor dSper matic Cor d

Contents

Ductus (vas) def er ns

Testicular arter y

a. to vas def er ns

Cr emaster ic a.

Testicular Vein (pampinif or m plexus)

Autonomic ner ve f iber sGenital branch of genitof emoral n.

(to cr emaster muscle)

Lymphatic vessels



Cover ing Fasciae of Sper matic Cor dCover ing Fasciae of Sper matic Cor d

Exter nal Sper matic Fascia:

fr om exter nal oblique m.

attached to superf icial r ing

Cr emaster ic Fascia:

the cr emaster m.

fr om inter nal oblique m.

Inter nal Sper matic Fascia:

transver salis fasciaattached to deep r ing



Contents of inguinal canal in maleContents of inguinal canal in male

3 arter ies

3 ner ves

3 fascial cover ings

3 diff er ent structur es: Vas def er ns1 venous plexus

Lymph vessels



Indir ect Her niaIndir ect Her nia

75% of inguinal her nias ar e indir ect

Males 20 > f emales

Part of the intestine pass thr ough thecanal

Commonly enter s

the scr otum



Dir ect Her niaDir ect Her nia

Usually medial to inf . epigastr ic a.

In Inguinal tr iagle ar ea:

inf . epig. A.

r ectus abdominis

inguinal lig.

For ms an inguinal sac by

transver salis fascia

Doesnot enter the scr otum



Abdominal CavityAbdominal Cavity



Per itoneum:Per itoneum:

def initiondef inition,, layer slayer s && or gan r elationsor gan r elations



Ter ms descr ibing parts of per itoneumTer ms descr ibing parts of per itoneum

Per itoneum has special names at specif ic r egions:

omentum

mesentr y & mesocolon

ligaments



Mesenter y & MesocolonMesenter y & Mesocolon

Mesenter y:double layer of per itoneum connects small

intestine to poster ior abdominal wall

mesentr y of small intestine

Mesocolon:double layer of per itoneum connects lar ge

intestine to poster ior abdominal wall

transver se mesocolon

sigmoid mesocolon

mesoappendix



Mesenter y & MesocolonMesenter y & Mesocolon



LigamentsLigaments((Ligaments of The Liver Ligaments of The Liver ))

Falcif or m

Cor onar y

Tr iangular s

Hepatoduodenal?

Ligaments not part of

per itoneum???



Spleen per itoneal ligamentsSpleen per itoneal ligaments

Gastr osplenic lig.

Splenico r enal lig.

(splenic arter y)



Or gans Relations to Per itoneumOr gans Relations to Per itoneumStomach (intra)

Duodenum

(r etr o, except 1st 2 cm)

Jejunum & ileum (intra)

Cecum & Appendix (intra)

Ascending (r etr o)

Transver se (intra)

Descending (r etr o)

Sigmoid (intra)

Rectum: within the pelvis

upper part (ant. & lat.)

middle part (ant.)

lower (no cover ing, subpertoneal)

Liver :Intraper itoneal

except over 3 ar eas

Pancr eas:

Retr oper itoneal

except f or the tail

Spleen:

Intraper itoneal

Kidneys:Retr oper itoneal



McBur ney¶s PointMcBur ney¶s Point

On a straight line : 1/3 fr om ant. sup. iliac spine2/3 fr om the umbilicus

Corr esponds to the base of the appendix

The incision site dur ing appendectomy (r emoval of the appendix)



Bile ducts systemBile ducts system



Abdominal

Vasculatur

eAbdominal

Vasculatur

e



Abdominal Aorta

Cavity branches

3 anter ior :

celiac trunk

Sup. Mesenter ic

Inf . Mesenter ic

3 lateral:

suprar enal

r enal

gonadal (testicular or ovar ian)

3 ter minations:

2 common iliacs (L4)

median sacral a.



Celiac Trunk Branches (Review)Celiac Trunk Branches (Review)



Super ior Mesenter ic

Arter y:

3 small intestine

3 lar ge intestine



Inf er ior Mesenter ic

Arter y:

3 lar ge intestine

branches



PortoPorto--Caval AnastomosesCaval Anastomoses

Portal

system

ana

stomose wi

th sys

temi

c(ca

val

) venou

s system

at 4 ar eas:

1. At abdominal esophagus:

esophageal veins drain into:azygos vein (systemic)

left gastr ic vein (portal)

2. At anal canal & r ectum:

r ectal veins drain into:

sup. Rectal vein (portal)

middle & inf . r ectal (systemic)



3. Ar ound the umbilicus:

paraumbilical veins (portal)

with lig. ter es inside falcif or m lig.

veins of ant. abd. Wall (systemic)

4. Poster ior (behind) to Ascending

& Descending colons:

colic veins (portal)

r etr oper itoneal veins of the wall(systemic)



PortoPorto--Caval Var icesCaval Var ices

A sign of portal hypertension & liver diseaseAt 4 r egions:

Ar ound esophagus:

esophageal var ices

(easily ruptur ed inter nal bleeding)

At anal canal:

hemorr hhoids

Ar ound umbilicus:caput medusa (head of Medusa)

Behind ascending & descending colons



Ner ves of Post. Abd. WallNer ves of Post. Abd. Wall

Subcostal n. (T12)

Lumbar ner ves (L1-L5)

L1 ± L4: f or m a network inside psoas ma jor m.

Lumbar plexus

L4 & 5 ± S4: f or m network in the pelvis

LumboSacral plexus

L4 &L5 branch to lumbosacral plexus is called:

lumbosacral trunk



Branches of Lumbar PlexusBranches of Lumbar Plexus

L1: iliohypogastr ic & ilioinguinal n.

Genitof emoral ner ve: (L1, L2)

ant. to psoas ma jor

divide into: genital branch ???

& f emoral branch (sensor y)

Femoral ner ve: (L2, L3, L4)

Obturator ner ve (L2, L3, L4)



KidneysKidneys

Cover ingsCover ings

Structur eStructur e

Draining systemDraining system

Structur es enter ing theStructur es enter ing the

hilumhilum



Kidneys RelationsKidneys Relations

Rt.K

idney

Sup.:

liver (Rt. Lobe)

suprar enal gland

Ant.:

Rt. Colic flexur e

2nd part of duodenum

Rt. Lobe of the liver

Post.:diaphragm

psoas ma jor

Quadratus lamborum



Kidneys RelationsKidneys Relations

Lf .K

idney

Sup.:

spleen

suprar enal gland

Ant.:

pancr eas

Lf . Colic flexur e

Post.:diaphragm

psoas ma jor

Quadratus lamborum

abdomen review 2011-12 e-learning

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