Download - The Abdomen
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The Abdomen
Surface Anatomy, Vessels, Muscles, and Peritoneum
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Surface Anatomy• Anterior abdominal wall
extends from costal margin to inferior boundaries:– Iliac crest– Anterior superior iliac
spine– Inguinal ligament– Pubic crest
• Superior boundary– Diaphragm
• Central landmark– Umbilicus
• Linea alba (white line)– Tendinous line– Extends from xiphoid
process to pubic symphysis
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Abdominal Quadrants
• 9 regions • 4 quadrants
– Draw “line” through navel
– Right upper quadrant
– Left upper quadrant
– Left lower quadrant– Right lower
quadrant
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Muscles• Function:
– Help contain abdominal organs
– Move trunk– Forced breathing– Increase intra-abdominal
pressure• Abdominal wall
– Anterior (4)• Innervated by intercostal
nerves• Continuous with layers of
intercostal muscles• Fibers of layers run in
different directions for strength
• Ends in aponeurosis which contains rectus abdominis muscle
– Posterior (3)
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Anterior Abdominal Wall Muscles
Rectus Abdominis – Origin
• Pubic crest, symphysis– Insertion
• Xiphoid process, costal cartilages of ribs 5-7
– Function • Flex, rotate trunk, fix and depress
ribs, stabilize pelvis, compress abdomen
• Internal oblique – Origin
• Lumbar fascia, iliac crest, inguinal ligament
– Insertion • Linea alba, pubic crest, last 3-4
ribs, costal margin– Function
• Same for external obliques
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Anterior Abdominal Wall
• External oblique– Origin
• Lower 8 ribs– Insertion
• Aponeurosis to linea alba, pubic and iliac crest
– Function • Flex trunk, compress abdominal
wall (together), Rotate trunk (separate sides)
• Transversus abdominis– Origin
• Inguinal ligament, lumbar fascia, cartilage of last 6 ribs, iliac crest
– Insertion• Linea alba, pubic crest
– Function• Compress abdominal contents
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Posterior Abdominal Wall• Iliopsoas
– Psoas major• Origin
– Lumbar vertebrae, T12
• Insertion– Lesser trochanter of femur via iliopsoas
tendon• Function
– Thigh flexion, trunk flexion, lateral flexion• Innervation
– Ventral rami L1-L3
– Iliacus• Origin
– Iliac fossa, ala of sacrum• Insertion
– Lesser trochanter of femur via iliopsoas tendon
• Function– Thigh flexion, trunk flexion
• Innervation– Femoral nerve (L2 and L3)
– Psoas minor – variable (40-60% do not have)
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Posterior Abdominal Wall
• Quadratus lumborum– Origin
• Iliac crest and lumbar fascia
– Insertion• Transverse process of
upper lumbar vertebrae, lower margin of rib 12
– Function• Flex vertebral column,
maintains upright posture, assists in inspiration
– Innervation:• T12 and upper lumbar
spinal nerves (ventral rami)
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Abdominopelvic Cavity
• Ventral body cavity– Thoracic– Abdominopelvic
• Abdominopelvic– Abdominal
• Liver• Stomach• Kidneys
– Pelvic cavity• Bladder• Some reproductive
organs• Rectum
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Abdominal cavity
The space bounded by:
• Anterolateral abdominal wall
• Posterior abdominal wall
• Diaphragm
• Pelvic walls and pelvic floor.
Subdivided into:
• True abdominal cavity (from diaphragm to linea terminalis)
• Pelvic cavity (below linea terminalis).
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Peritoneum and peritoneal compartment
Peritoneum is a continuous serous membrane, composed of two layers:
• Parietal peritoneum, lines abdominal and pelvic wall
• Visceral peritoneum, lines abdominal and pelvic
organs.
Peritoneal compartment is part of the abdominal cavity enclosed within the parietal peritoneum. Contains organs covered with peritoneum and peritoneal structures.
Outside the parietal peritoneum is the extraperitoneal compartment of the abdominal cavity.
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Peritoneal cavity
Peritoneal cavity (PC) - the space between the two peritoneal layers, is a potential space, into which the organs are tightly packed against each other.
•PC contains thin layer of fluid, which lubricates the peritoneal surfaces and allows movement of the organs without friction.
•PC is closed in males, but communicates with the external environment in females through the uterine tubes, uterus and vagina.
•Peritoneum, peritoneal cavity and all the organs are situated in the abdominal cavity.
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Development of the peritoneum
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Relationship between the organs and peritoneum
Due to intraembryonal processes the organs have different relationship with the peritoneum.
1. Intraperitoneal organs are entirely covered with peritoneum. They are connected to the abdominal wall with ligaments or meso, which ensures greater mobility.
2. Extraperitoneal organs are partially or entirely devoid of peritoneum. They are slightly movable or immovable. According to their position these are:
а) retroperitoneal – on the posterior abdominal wall
b) subperitoneal – in the lesser pelvis
c) preperitoneal – at the anterior abdominal wall.
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Vertical layout of the peritoneum
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Horizontal layout of the peritoneum
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Passage of the parietal into visceral peritoneum
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Peritoneal structures
1. Mesentery – double peritoneal layer, representing
elongation of the visceral peritoneum.
•М. connects the corresponding organ with the
abdominal wall (e.g., mesentery of the small
intestine).
•М. contains connective tissue in which are
embedded blood vessels, nerves and lymph nodes.
•М. ensures mobility of the organs.
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2. Omentum – double layered structure
of visceral peritoneal, extending from
the stomach to neighbouring organs.
• Lesser omentum (оmentum minus)
connects the lesser curvature of the
stomach and intitial portion of pars
superior duodeni with liver.
• Greater omentum (оmentum majus)
descends from the greater curvature of
the stomach and intitial portion of pars
superior duodeni, covers the intestines,
and then ascends back to attache to the
transverse colon. Contains great amount
of fat tissue.
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3. Peritoneal ligaments – double layered
structures of visceral peritoneum, between
neighbouring organs or between organ and
abdominal wall (e.g., lig. falciforme, lig.
gastrophrenicum, lig. gastrolienale, lig.
gastrocolicum).
4. Peritoneal folds (plicae) formed over
underlying structures (e.g., plica iliocecalis
superior, plica umbilicalis mediana).
5. Peritoneal recessuses – spaces in the peritoneal
cavity заградени between peritoneal structures
and abdominal organs or abdominal wall (e.g.,
bursa omentalis, recessus subphrenicus, fossa
retrocecalis).
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Divisions of the peritoneal cavity
By mesocolon transversum the peritoneal compartment divites into:
1. Supracolic compartment – between diaphragm and mesocolon transversum with its mesentery.
2. Infracolic compartment - between mesocolon transversum and linea terminalis.
3. Pelvic compartment - below linea terminalis in the pelvi cavity.
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Supracolic compartment
Organs:
1. Esophagus, pars abdominalis -
intraperitoneal
2. Stomach - intraperitoneal
3. Liver - intraperitoneal
4. Gall bladder - intraperitoneal
5. Spleen - intraperitoneal
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Supracolic compartment. Projections of organs
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Supracolic compartment
Peritoneal structures: 1. Lig. falciforme hepatis
– lig. teres hepatis
2. Lig. coronarium hepatis (dextum et sinistrum)
– area nuda
3. Lig. triangulare (dextum et sinistrum)
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Supracolic compartment
4. Omentum minus
– lig. hepatogastricum– lig. hepatoduodenale
5. Omentum majus– lig. gastrocolicum– lig. gastrolienale– lig. gastrophrenicum
6. Lig. phrenicolienale
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Supracolic compartment
Peritoneal spaces:
1. Recessus subphrenicus dexter - bursa hepatica
2. Recessus subphrenicus sinister - bursa pregastrica
3. Perilienal space
4. Recessus subhepaticusа) anterior part
b) posterior part - recessus hepatorenalis
5. Bursa omentalis
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Supracolic compartment
Bursa omentalis. Opened thru lig. gastrocolicum
Bursa omentalis. Opened thru lig. hepatogastricum
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Infracolic compartment
Organs:
1. Small intestine– duodenum (pars superior, descendens, horizontalis,
ascendens) - retroperitoneal, pars superior intraperitoneal
– Jejunum and ileum - intraperitoneal
2. Large intestine– cecum - intraperitoneal
– appendix vermiformis - intraperitoneal
– colon (ascendens, transversum, descendens, sigmoideum) - intraperitoneal /mesoperitoneal
– rectum – most extraperitoneal
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Organs and projections
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Peritoneal structures
1. Omentum majus - pars libera
2. Mesenterium
3. Mesocolon transversum
4. Mesocolon sigmoideum
5. Mesoappendix
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Peritoneal structures
1. Plicae duodenalis superior/inferior
- recessus duodenalis superior/inferior
2. Plicae ileocecalis superior/inferior
- recessus ileocecalis superior/inferior
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Peritoneal spaces
1. Canalis lateralis dexter
2. Sinus mesentericus dexter
3. Sinus mesentericus sinister
4. Canalis lateralis sinister
5. Recessus intersigmoideus
6. Recessus retrocecalis
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Appendix vermiformis
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Supracolic compartment. Blood supply
Truncus celiacus
1. A. gastrica sisnistra- r. esophageus
2. A. hepatica communis- a. hepatica propria
- a. hepatica dextra/sinistra- a. gastroduodenalis
- a. gastroepiploica dextra- aa. pancreaticoduodenales
superiores (anterior/posterior)
- a. gastrica dextra
3. A. lienalis- aa. gastricae breves- a. gastroepiploica sinistra
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Supracolic compartment. Blood supply
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Arteriogram of truncus celiacus
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Infracolic compartment. Blood
supply
A. mesenterica superior
1. A. pancreaticoduodenalis inferior
2. Aa. intestinales (15-18)
3. A. iliocolica
4. A. colica dextra
5. A. colica media
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Infracolic compartment. Blood
supply
A. mesenterica inferior
1. A. colica sinistra
2. Aa. sigmoideae (3-4)
3. A. rectalis superior