abdominal wall 山东大学医学院 解剖教研室 李振华. anterior wall layers ( from...
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Abdominal wall
山东大学医学院 解剖教研室李振华
Anterior wall Layers ( from superficial to dee
p) Skin Superficial fascia Anterolateral muscles Transversalis fascia
腹横筋膜 Extraperitoneal fascia
腹膜下筋膜 Parietal peritoneum
壁腹膜
Superficial fascia - divisions below umbilicus
Superficial fatty layer (Camper’s)
Membranous layer (Scarpa’s)
Muscles of abdomen
Anterolateral group Obliquus externus abs
ominis 腹外斜肌 Oblequus enternus ab
dominis 腹内斜肌 Transversus abdomini
s 腹横肌 Rectus abdominis 腹
直肌
Posterior group Quadiatus lumborum
腰方肌 Psoas major 腰大肌
Obliquus externus absominis 腹外斜肌General direction of fibers: d
ownward, forward and medially (run down and inward)
Structures Inguinal ligament
腹股沟韧带 Lacunar ligament
腔隙韧带 Superficial inguinal ring
腹股沟浅环 - triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle
Obliquus internus abdominis 腹内斜肌 Deep to obliquus exter
nus abdominis General direction of fi
bres: upwards, forwards and medially
Transversels abdominis 腹横肌
Deep to obliquus internus
Inguinal falx 腹股沟镰 : arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis
Cremaster 提睾肌 : around the spermatic cord and testis
Rectus abdominis 腹直肌 Position: lie on to either of midli
ne Origin: pubic crest and symphys
is Insertion: xiphoid and 5th-7th c
ostal cartilages Has 3-4 tendinous intersection
s 腱划 linea semiluaris 半月线
Similar functions for above four pairs of muscles
Support and compress the abdominal viscera Increase intra-abdominal pressure, aid in expulsive
efforts-vomiting, coughing, sneezing, defecation, urination and childbirth.
Depress ribs, assist in (the act of force(4)expiration. Flex, lateral flex, and rotate vertebral column
Sheath of rectus abdominis 腹直肌鞘Ant layer - formed by fusion of apone
urosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis
Post layer Formed by fusion of posterion leaf
of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominis
Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line
Below this line rectus abdominis in contact with transverse fascia
Linea alba 白线- tendinous raphe between right and left recti from xiphoid to pubic symphysis.
Inguinal region 腹股沟区
Boundaries Inguinal ligament Lateral margin of rec
tus abdominis A horizontal line stre
tching from anterior iliac spine to laeral margin of rectus abdominis
Descent of testes
Seven-week embryo showing the testis before its descent from the dorsal abdominal wall
Fetus at 28 week the testis passing through the inguinal canal
Newborn
Inguinal canal 腹股沟管Position: oblique passage, 4cm long, located 1.5cm ab
ove medial half of inguinal lig.
Boundaries Ant wall
Aponeurosis of obliquus externus abdominis
Obliquus internus abdominis (lateral third of wall)
Post wall Transverse fascia Inguinal flax medially
Roof - arched lower fibers of obliquus internus and transversua abdominis
Floor - inguinal lig .
Two openings Superficial inguinal ring 腹股
沟浅环 Deep inguinal ring 腹股沟深环
- defect in transverse fascia 1.5cm above midpoint of inguinal ligament
Structures passing through the inguinal canal Spermatic cord 精索 and ilioinguinal nerve 髂腹股沟神经 in males Round ligament of uterus 子宫圆韧带 and ilioinguinal nerve 髂腹
股沟神经 in females
Inguinal Triangle (of Hesselbach) 腹股沟三角
Boundaries Inguinal ligament infe
riorly Lateral border of rect
us abdominis medially
Inferior epigastric artery laterally
Indirect inguinal heinia and direcet inguinal heinia
Superficial vessels and cutaneous nerves Arteries
Superficial epigastric a. Superficial iliac circumflex a.
Veins Thoracoepigastric v. Superficial epigastric v.
Cutaneous nerves Anterior and lateral cutaneou
s n. of lower six thoracic Iliohypogastric n. (first lumb n
erves)
Deep vessels and nerves
Arteres Superior and inferior epigastric arteris Lower posterior intercostal a. Subcostal a. Four lumbar a.
Nerves Iliohypogastric n. 髂腹下神经
Arises from lubar plexus Passes forward in the interval b
etween obliquus internus and tranversus abdominis
Pieces obliquus internus abdominis 2.5 cm medial to anterior superior iliac spine
Pieces aponeurosis of obliquus externus abdominisabout 2.5 cm above superficial inguinal ring
Ilioinguinal n. 髂腹股沟神经 Runs parallel with iliohypogastr
ic n. at a lower level Enters inguinal canal and emer
ges through superficial inguinal ring
Genitofemoral n. 生殖股神经
Subcostal incision
Muscle-splitting incision
Transverse incision
Median or midline incision
Left paramedian incision
Layer Layer ??
Suprapubic incision
Abdomen 2
山东大学医学院 解剖教研室李振华
Abdominal aorta 腹主动脉
Continuation of thoracic aorta at aortic hiatus of diaphragm in front of T12
Terminates at lower border of L4 vertebra by dividing into right and left common iliac arteries
Parietal branches Inferior phrenic a. 膈
下动脉 (one pair) Lumbar a. 腰动脉 (fou
r pairs of arteries that supply the posterior abdominal wall)
Median sacral a. 骶正中动脉
Visceral branches Paired branches
Middle suprarenal artery 肾上腺中动脉
Renal artery 肾动脉 Testicular (ovarian) art
ery 睾丸(卵巢)动脉
Unpaired branches Celiac trunk 腹腔干 -
a short thick vessel that arises from the front of aorta, at the level of T12
Superior mesenteric a. 肠系膜上动脉- arises from the front of aorta, at the level of L2
Inferior mesenteric a. 肠系膜下动脉 - arises from the front of aorta, at level of L3
Left gastric a.
Common hepatic a.
Splenic a.
Gastroduodenal a.
Proper hepatic a.
Right gastric a.
Left branch
Right branch
Cystic a.
Short gastric a.
Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
Splemic branches
Celiac trunk
Celiac trunk
Superior mesenteric a.
Inf. pancresticodudenal a.
Jejunal and ileal a.Ileocolic a.
Appendicular a.
Right colic a.
Middle colic a. Superior Mesenteric v.
Inferior mesenteric a.
Left colic a.
Sigmoid a.
Superior rectal a.
Inferior mesenteric v.
Colic marginal artery
Relations of abdominal aorta Anteriorly (from above down
ward) Pancreas Ascending part of duodenu
m Radix of mesentery
Posteriorly Upper four lumber vertebra
e On its right
Inferior vena cava On its left
Left sympathetic trunk
Veins of abdomen and pelvisInternal iliac vein 髂内静脉 Parietal tributaries: accompany with arteries Visceral tributaries
→superior rectal vein→inferior mesenteric
v.
①Rectal venous plexus →inferior rectal vein→internal iliac v.
直肠静脉丛 → anal vein→internal pudendal v.
②Vesical venous plexus 膀胱静脉丛→ vesical v.
③Uterine venous plexus 子宫静脉丛→ uterine v.
External iliac vein
髂外静脉– accompany the artery
Common iliac vein 髂总静脉– formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4~L5 by uniting each other to form inferior vena cava
Inferior vena cava 下腔静脉 Formed by union of two
common iliac veins anterior to and just to the right of L4~L5
Ascends on the right side of aorta, pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atrium
Conveys blood from the whole body below the diaphragm to the right atrium
Chief tributaries Parietal
Paired inferior phrenic v. 膈下静脉
paired lumbar v. 腰静脉 (four)
Visceral Right and left renal veins
左、右肾静脉 Right suprarenal vein
右肾上腺静脉 (left drain into left renal vein)
Right testicular or ovarian v右睾丸(卵巢)静脉 . (left drain into left renal vein)
Hepatic veins 肝静脉 : right, left and intermediate
Relations of inferior vena cava Anteriorly (cranially to caudally)
Liver Head of pancreas Horizontal part of duodenum Right testicular (or ovarian) a. Radix of mesentery
Posteriorly Right crus of diaphragm Upper four lumber vertebrae Left sympathetic trunk Parietal branches of abdominal aorta
On its right Psoas major Right kidney Right suprarenal gland
On its left Abdominal aorta
Hepatic portal vein 肝门静脉General features Formed behind the neck of pa
ncreas by the union of superior mesenteric vein and splenic vein
Ascends upwards and to the right, posterior to the first part of duodenum and then enters the lesser omentum to the porta hepatis, where it divides into right and left branches
There are no functioning valves in hepatic portal system
Drains blood from gastrointestinal tract from the lower end of oesophagus to the upper end of anal canal, pancreas, gall bladder, bile ducts and spleen
Variation and anomalies of hepatic portal vein
Tributaries of hepatic portal vein
1. Superior mesenteric v. 肠系膜上静脉
2. Inferior mesenteric v. 肠系膜下静脉
3. Splenic v. 脾静脉4. Left gastric v. 胃左静脉5. Right gastric v. 胃右静脉6. Cystic v. 胆囊静脉7. Paraumbilical v.
附脐静脉
Portal-systemic anastomoses1. At the lower end of the oesophagus Hepatic portal vein → left gastric vein → esophageal venous plexus → esophageal vein → azygos vein → superiorvena cava
2. At rectal venous plexus Hepatic portal vein → splenic vein → inferior mesenteric vein → superior rectal vein → rectal venous plexus → inferior rectal and anal veins → internal iliac vein → inferior vena cava
3. At periumbilical venous plexus Hepatic portal vein→paraumbilical vein→periumbilical venous plexus→
thoracoepigastric and superior epigastric vein → superiorvena cava
superficial epigastric and inferior epigastric veins → inferior vena cava
4. Portal-retroperitoneal anastomosis Between the retroperitoneal branches of the colic ve
ins and the lumbar veins, pancreaticoduodenal veins with the renal veins and the subcapsular veins of the liver with the phrenic veins twigs of colic veins (portal) anastomosing with systemic retroperitoneal veins
The lymphatic drainage of abdomenLymphatic drainage of abdo
minal wall To axillary lymph node from
region above umbilicus To superficial inguinal lymp
h node from region below umbilicus
To lumbar lymph node from post wall of abdomen
Lymphatic drainage of abdominal viscera
Lumbar lymph nodes 腰淋巴结 Lie on posterior abdominal
wall, along the abdominal aorta and inferior vena cava
Receive lymph from kidneys, suprarenal glands, testes, ovarirs, fundus of uterus, ovary, and common iliac nodes
Right and left lumbar trunks formed by efferent vessel
Paired viscera - drain to the lumbar lymph nodes
Celiac lymph nodes 腹腔淋巴结 - situated around the celiac trunk
Superior mesenteric lymph node 肠系膜上淋巴结 -situated around superior mesenteric a.
Inferior mesenteric lymph node 肠系膜下淋巴结 - situated around inferior mesenteric a.
Intestinal trunk 腹腔干 -formed by efferent vessel of celiac, superior and inferior lymph nodes
Thoracic duct 胸导管 Begins in front of L1 as a dilated sac, the ci
sterna chyli, which formed by joining of left and right lumbar trunks and intestinal trunk
Enter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column, between thoracic aorta and azygos vein
Travels upward, veering to the left at the level of T5
At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angle
Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks
Drains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb
Spleen 脾
Location: lies in the left hypochondriac region (between stomach and diaphragm) deep to the 9th to 11th rib, its long axis corresponds roughly to the 10th rib
Shape - reddish in colour
Two surfaces Diaphragmatic: smooth, convex Visceral: concave, hilum of spleenTwo extremities Anterior - wider Posterior - rounderTwo border Superior - has 2-3 splenic notch 脾切迹 , w
hich serve as a landmark on palpation when it is enlarge; normally it is not palpable
Inferior - rounderFunctions: the spleen is considered to be impor
tant in: Formation of lymphocytes and monocyte Phagocytosis of bacteria, inert particles and
white blood cells and platelets Destroying effete or abnormal red blood cells Making antibodies
Ralationships of spleen Diaphragmatic surfac
e - diaphragm Visceral surface
Anteriorly - fundus of stomach
Posteriorly - left suprarenal gland and kidney
Inferiorly - tail of pancreas and left colic flexure
Nervers of abdomen Lumbar plexus 腰丛 Formation: formed by a
nterior rami of L1-L3, a part of anterior rami of T12and L4
Position: lies within substance of psoas major
Branches Iliohypogastric n. 髂腹下神经
Supplies lower part of anterior abdominal wall
Ilioinguinal n. 髂腹股沟神经Passes through inguinal canal to supply skin of the groin and scrotum
Lateral femoral cutaneous 股外侧皮神经
Femoral n. 股神经 Obturator n. 闭孔神经 Genitofemoral n. 生殖股神经
Lumbar sympathetic trunk 腰交感干 Made up of paired chains wi
th four to five lumbar ganglia anterolateral to vertebral column
Enters abdomen via the diaphragm and as a continuation of he thoracic part
Passes inferiorly behind common iliac vessels and terminations by joining to form unpaired ganglion impar, anterior to sacrum
Abdomen 3
山东大学医学院 解剖教研室李振华
Relationships of abdominal viscera First layer - live, gallbladder, stomach Second layer - duodenum, pancreas, spleen Third layer - suprarenal gland, kidney, urete
r, inferior vena cava, abdominal aorta, nerves and lymphatics
Relationships of the stomach Anterior:
Live (right part) Diaphragm (left upper part) Anterior abdominal wall (left lo
wer part) Posterior - separated by perit
onum of lesser sac from the following (“stumach-bed”) Pancreas Left suprarenal gland Left kidney Spleen Transverse colon and transver
s mesoclon
Arteries of stomach
Left and right gastric arteries arise from celiac trunk and proper hepatic artery, repectively. These two vessels run in lesser omentum along lesser curvature , and anastomose end-to-end.
Right and left gastroepiploic arteries arise from the gastroduodenal and splenic artery, repectively. These two vessels pass into the greater omentum, run parallel to the greater curvature, and anastomose end-to-end.
Short gastric arteries, branches of splenic artery, course through the gastrosplenic ligament and supply the fundus of stomach.
Posterior gastric artery (72%) arise from the splenic artery, course through the gastrophrenic ligament and supply the posterior wall of fundus of stomach.
Venous drainage Right and left gastric veins empty directly into hepatic portal vein. Left gastroepiploic and short gastric veins drain into hepatic portal ve
in via the splenic vein. Right gastroepiploic vein join either superior mesenteric vein.
Lymphatics of stomach Right and left gastric ln. lie alon
g the same vessels and finally to the celiac ln.
Right and left gastroomental ln. lie along the same vessels, the former drain into subpyloric ln., the latter drain into splinic ln.
Supra- and subpyloric ln. receive lymphatics from pyloric part and finally to the celiac ln.
Splenic ln. receive lymphatics from fundus and left third of stomach, and finally to the celiac ln.
Nerve supplyParasympathetic innervation by anteri
or (left) and posterior (right) vagal trunks
The anterior trunk divides into anterior gastric and hepatic branches
The posterior trunk divides into posterior gastric and celiac branches
The anterior and posterior gastric branches descend on the anterior and posterior surfaces of the stomach as a rule about 1 to 2 cm from the lesser curvature and parallel to it in the lesser omentum as far as thr pyloric antrum to fan out into branches called “crow’s foot” to supply the pyloric part
Sympathetic innervation Mainly from celiac ganglia Affent and effent fibers derives from
thoracic segments (T5 - L1
The duodenum
Relationships of superior part Anteriorly
Quadrate lobe of live Gallbladder
Posteriorly Commom bile duct Gastroduodenal a. Hepatic portal v. Inferior vena cava
Superioely Omental foramen
Inferiorly Head of pancreas
Relationships of descending part
Anteriorly Live Transverse colon and meso
colon Loops of small intestine
Posteriorly Right renal hilum and ureter Right renal vessels
Medially Head of pancreas Common bile duct and panc
reatic duct Laterally
Right colic flexure
Relationships of horizontal part
Superiorly Head of pancreas Inferiorly
Loops of small intestine Anteriorly
Radix of mesentery Superior mesenteric a. and
v. Posteriorly
Right ureter Inferior vena cava Abdominal aorta
Relationships of ascending part Right
Head of pancreas and abdominal aorta Left
Left kidney and ureter
Relationships of liver
Diaphragmatic surface - separated by diaphragm from the following Right costodiaphramatic reces
s and lung Cardiac base
Visceral surface Left lobe is related to the stom
ach and abdominal part of esophagus
Right lobe is related to the right colic flexure anteroly, gallbladder and superior duodenal flexure medially, right kidney, superarenal gland posteriorly
Blood supply Arteries
Superior pancreaticoduodenal a.
Inferior pancreaticoduodenal a.
Veins - follow arteries, draining directly into superior mesenteric and hepatic portal veins
Divisions and relations of common bile duct
Supraduodenal segment Descends along the right marg
in of hepatoduodenal lig. To the right of proper hepatic a. Anterior to hepatic portal v.Retroduodenal segment Behind the superior part of duo
denum Anterior to the vena cava To the right of the hepatic port
al v.
Pancreatic segment Lies in a groove between po
sterior surface of head of pancreas and duodenum
Intraduodenal segment Enters the wall of descendin
g part of duodenum obliquely where jions the pancreatic duct to form the hepatopancreatic ampulla
opens at the major duodenal papilla
Divisions and relations of pancreasHead of pancreas Located in C-shapes curvature
of doudenum Anteriorly
Transverse mesocolon Posteriorly
Inferior vena cava Right renal vessels Common bile duct
Neck of pancreas Anteriorly - pylorus Posteriorly - commencement pf
hepatic portal v. (formed by union of splenic and superior mesenteric veins
Body of pancreas Anteriorly
Separated from stomach by omental bursa
Posteriorly Abdominal aorta Left suprarenal gland Left kidney Left renal vessels Spleen vein
Superiorly Celiac trunk Celiac plexus Splenic a.
Tail of pancreeas Runs in spleicorenal liga
ment to reach hilum of spleen
Accompanies with splenic vessels
Relationships of spleen
Diaphragmatic surface- diaphragm
Visceral surface Anteriorly - fundus of sto
mach Posteriorly - left suprare
nal gland and kidney Inferiorly - tail of pancre
as and left colic flexure
Left gastric a.
Common hepatic a.
Splenic a.
Gastroduodenal a.
Proper hepatic a.
Right gastric a.
Left branch
Right branch
Cystic a.
Short gastric a.
Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
Splemic branches
Celiac trunk
Superior mesenteric a.
Inf. pancresticodudenal a.
Jejunal and ileal a.Ileocolic a.
Appendicular a.
Right colic a.
Middle colic a. Superior Mesenteric v.
Inferior mesenteric a.
Left colic a.
Sigmoid a.
Superior rectal a.
Inferior mesenteric v.