RADIOLOGICAL ANATOMY OF ABDOMEN

SECTION OF RADIOLOGY (I.M.) DEPARTMENT OF SHALYA TANTRA, IMS-BHU

Presented by – Guided by – Dr . Madan jakhar Prof S.S. MISHRA

INDEXA)Landmarks of abdomen

B).Radiological modalities use for abdomen

C)Surface and radiological anatomy of different organs of abdomen

1) Liver2) Gall bladder3) Pancreas4) Spleen5) Stomach6) Small Intestine 7) Large Intestine 8) Kidney & Ureter –Right & Left9) Urinary Bladder

Surface Anatomy-Quadrants & Regions Upper transverse

plane. Lower transverse

plane. Sagittal planes at

right angles to transverse planes divide the abdomen into four quadrants and nine regions .

Transverse planesTrans pyloric plane-liesA lower border of L1Trans tubercular plane-lies Upper border of L5Sagittal planes- Median vertical planes- Symphysis pubis to supra –Sternal notchRt & Lt Verticalplanes -

Abdomen Radiography-Quadrants

Imaging Modalities for the Abdomen and Pelvis.

Commonly utilized modalities :• Ultrasound• CT (computed tomography)• Abdominal plain film• Fluoroscopy• Hysterosalpingography

Other modalities: •MRI [Magnetic resonance imaging]• Nuclear medicine• Gallium scan• Positron Emission Tomography (PET).

X ray Abdomen

The most common plain radiograph of the abdomen is an anteroposterior (AP) view with the patient in the supine position.

The AP view of the abdomen is also called a KUB film because it includes the kidneys, ureters, and bladder.

When acute abdominal disease is suspected clinically, an erect film of the abdomen and a posteroanterior (PA) view of the abdomen are also required.

Abdomen - plain film Anatomy

A Normal plain film of the abdomen. The lower margins of the posterior portion of the liver, the hepatic angle (H), and the lower part of the spleen (S) are delineated by a fat shadow. Both kidneys (K) and the psoas muscle shadows (arrowheads) are outlined by a fat shadow. The properitoneal fat stripe is also shown bilaterally (arrows).

STOMACHWITHOUT CONTRAST

COLON

UPPER GI ORAL BARIUM CONTRAST.

BARIUM ENEMA.

Abdomen Anatomy-Liver

Liver- present in RUQ. Two major lobes two minor lobes.

Falciform ligament separates larger Rt lobes from Lt lobe ,small quadrate lobe lies inferior to Rt lobe and posterior to quadrate lobe lies caudate lobe

Liver-Introduction Occupies the right hypochondrium, epigastrium & left

hypochondrium.

Most part of the liver is covered by ribs & costal cartilages.

It is covered by network of connective tissue (Glisson’s Capsule)

1cm

1cm1cm

4-5cm

8th rib

Xiphisternal j 5R

6-12cm4-8cm

IMAGE OF PORTA HEPATIS SHOWING CBD & MAIN PORTAL VEIN

Biliary Apparatus :

It collects bile from the liver ,stores in the gallbladder & transmits to 2nd part of duodenum.

Gall bladder. Cystic duct. Right and left hepatic ducts which unite

to form Common Hepatic Duct. Common Bile duct formed by the union

of cystic duct and common hepatic duct.

Parts of Gall Bladder

Fundus Body Neck Infundibulum Cystic duct

Gall Bladder Gall bladder – a pear shaped sac and reservoir of

bile and is responsible for concentration of bile. It can hold upto 30-50 ml.

9-10 cm long , 4 cm in diameter. Wall thickness < 3mm. Hangs from inferior surface of liver – fundus usually

anterior and inferior to body and neck. Cystic duct arises from the neck of the gallbladder. Neck and cystic duct has spiral appearance to the

mucosal folds (spiral valve of heister); on ultrasound it is highly echogenic and may be mistaken for gallstones.

Radiological anatomy

Gb stones-Cholesterol and pigment stones are radiopaque and visible on radiographs .

Porcelain Gall Bladder

Gross Anatomy of the Stomach cardiac end - at the level of T11

pylorus end – at the level of L2 Lesser curvature -1. Greater curvature 2. Cardia - end under the heart3. Fundus - bulge above the esophageal

opening4. Body - largest region5. Pylorus - J curve, inferior end, terminates in 6. Pyloric sphincter and superior end

terminates in 7. Cardiac spincter. 8. Rugae – highly extendable interior folds Figs 25-10/11

Abdomen Anatomy-Pancreas

PPancreas is transversely placed between L1 and L2. it has three parts head,body and tail .

It is partly exocrine and partly endocrine . Endocrine part secretes insulin and glucagon . Exocrine part secretes pancreatic juice .

The pancreatic duct opens in to second part of duodenum .

Pancreas and its proportions + neighboring anatomical structures in classic transverse epigastrial plain.

Spleen :

Spleen is the largest organ of lymphatic system in human body.

Location: Lies along the axis of 10th rib. Size: normally varies from 7 to 12 cm in

length,7.5 cm broad and 2.5 cm thick. In usg - . Homogenous, moderately

echogenic ( pancreas > liver > spleen ) • Visualized best obliquely in the 9th or

10th inter costal spaces

Normal spleen.

Kidneys, Ureters and Urinary Bladder Tract (KUB) KIDNEY -Usual

location – between upper border of 12th thoracic vertebra and lower border of 3rd lumbar vertebra

On either side of the lower thoracic and upper lumbar spine

Relationship of the Kidneys to Vertebra and Ribs

12×6×3

Intravenous Pyelogram shows Kidneys, Ureters and Urinary Bladder

Long axis of the kidneys is directed downward and outward, parallel to the lateral border of the psoas muscles

Ultrasound of Right Kidney

Ureters

25-30 cm in length and 2-8 mm diameter

Course downwards from the most dependent portion of the pelves to the midsacral region

Then turn posterolaterally and course in an arc downwards

Then inward and anteriorly to enter the trigone of the bladder on either side of the midline

Urinary Bladder

Neck of bladder - lies 3-4 cm behind lower part of symphysis pubis and rests on the prostate in the male

It has the urethral orifice In females the peritoneum is reflected

from the superior surface of the bladder to the anterior wall of the uterus at the junction between the body and cervix

The enclosed space is the vesicouterine pouch

Urinary Bladder

Transverse image through a normal bladder using ultrasound shows normal anechoic structure.

X ray showing urinary bladder stones

Regions of Small Intestine

SI is longest part of dig. tube Duodenum (short, 12 inches)

fixed shape & position Mixing bowl for chyme

Jejunum (2.5 m long) Most of digestion

Ileum (longest at 3.5 m) Most of absorption, ends in

Ileocecal valve – slit valve into large intestine (colon)

Cecum – pocket at proximal end with Appendix

ColonAscending colon - on right, between cecum and right colic flexureTransverse colon - horizontal portionDescending colon - left side, between left colic flexure and Sigmoid colon - S bend near terminal end

Regions of Large Intestine

Fig 25-17

Rectum – terminal end is anal canal - ending at the anus - which has internal involuntary sphincter and external voluntary sphincter

Summary of this ppt

Diameters- Liver - < 14.5 cm 12- 15 mild Spleen - < 12 cm >15 modrate >18 gross

spleenomegaly Kidney - 8 – 12 cm

30 mm head Pancrease - 20 mm body 25 mm neck

wall thikness

GALL BLADDER URINARY BLADDER 3 MM SMALL BOWEL

Luminal diameter SMALL BOWEL 3 CM LARGE BOWEL 6 CMCACEUM 9 CM -

DIAMETERS OF TUBULAR STRUCTURES: - PORTAL VEIN - < 12 MM HEPATIC VEIN - < 9 MM < 6 MM - ADULT CBD - < 8 MM - OLD < 10 MM – POST

CHOLECYSTECTOMY • IVC - <25 MM

• PANCREATIC DUCT - < 2 MM

To be continued….

The end … .. .