pmdc neb step-1 day-6 (review of abdomen)
TRANSCRIPT
9
Trunk
1. Liver
2. Asc. colon
3. Sigmoid colon
4. Heart
5. Trans colon
6. Desc. colon
7. Small Bowel
Abdominal incisions
Median
Paramedian
Transverse
Subcostal- Kocher’s
Supra pubic- Pfannenstiel
Morrison’s
Grid Iron- McBurney
Find and identify palpable landmarks that
clinicians use to locate internal structures
Use landmarks to locate
only those structures
examined during the
physical exam
Surface anatomy to introduce the physical exam
Ccommon surgical incisionsUse the incisions to compare andcontrast different regions of the abdominal wall
© 2010 Lawrence Rizzolo, Ph.D., Yale University
TOS# Themes %
1 Dysphagia 5
2 Dyspepsia 10
3 Jaundice 10
4 Acute Pancreatitis 10
5 Acute Abdomen 25
6 Diarrhea 10
7 Lower GIT bleed 10
8 Inguino-scrotal swellings 5
9 Nutrition 15
Grand Total 100%
• Hollow muscular tube that transports food &
liquid to the stomach
• Extends from pharynx to stomach
• Follows curve of vertebral column
• Pierces diaphragm at level of T10 vertebra
• Covered anteriorly & laterally in abdomen by
peritoneum= retroperitoneal
• Arterial supply
inferior phrenic artery
left gastric artery
• Venous drainage
left gastric vein
OESOPHAGUS
PARTS OF STOMACH
Angular notch : along lesser curvature; junction of body & pyloric part
Cardia : around opening of oesophagus
Fundus : dilated superior part - related to left dome of diaphragm
Body : between fundus & pyloric antrum
Pyloric part : has 2 parts - pyloric antrum & pyloric canal
Intestinal mucosa bears :
• transverse folds =
plicae circulares
• small projections =
intestinal villi
• both increase surface
area for absorption
• each villus contains a
terminal lymphatic
called a lacteal
PARTS OF SMALL INTESTINEExtends from pylorus to ileocaecal junction
Includes duodenum, jejenum, ileum
Small intestine plays primary role in digestion & absorption of nutrients
FIRST PART OF SMALL INTESTINE : DUODENUM
• Shortest, widest, most fixed part
• Has C-shaped course around head of pancreas
• Begins at pylorus; ends at duodenojejunal
junction
ARTERIAL SUPPLY
• Superior pancreaticoduodenal artery
(coeliac trunk)
• Inferior pancreaticoduodenal artery
(superior mesenteric artery)
VENOUS DRAINAGE
• Follow arteries - drain into portal vein
• Bile & pancreatic ducts enter its posteromedial
wall
• Duodenojejunal flexure : Junction of duodenum
& jejunum
• Begins as a pouch inferior to terminal portion of ileum
• Ends at anus
Functions :
1. Reabsorb water, compact feces
2. Absorb vitamins liberated
by bacteria
3. Store fecal material before
defecation
LARGE INTESTINE : FUNCTIONS
3 components viz.
1. CECUM
• Collects, stores chyme
• Ileocecal valve opens into it
2. COLON
• Bears haustra, taeniae coli, epiploic
appendages
• Subdivided into 4 regions
ascending
transverse
descending
sigmoid
• Terminates in anorectal canal
PARTS OF LARGE INTESTINE
3. RECTUM
• Leads to anus
• Muscular sphincters control passage of
fecal material to anus
PARTS OF LARGE INTESTINE: CAECUM
• First part of large intestine
• Continuous with ascending
colon
• Lies in iliac fossa
• Does not have a mesentery
• Has vermiform appendix
attached inferior to ileocaecal
junction
• Appendix has short triangular
mesentery = mesoappendix- that
suspends it from mesentery of
terminal ileum
PARTS OF LARGE INTESTINE: ASCENDING COLON
• Passes superiorly from caecum on
right side of abdominal cavity to
liver, turns to left as right colic
flexure
• Lies retroperitoneally along side
posterior abdominal wall
• Covered with peritoneum anteriorly
& on its sides
• Separated from anterior abdominal
wall by coils of small intestine &
greater omentum
PARTS OF LARGE INTESTINE: TRANSVERSE COLON
• Largest, most mobile part
• Crosses abdomen from right
colic flexure to left colic
flexure - bends inferiorly to
become descending colon
PARTS OF LARGE INTESTINE: DESCENDING COLON
Passes retoperitoneally from left
colic flexure into left iliac fossa,
becomes continuous with sigmoid
colon
PARTS OF LARGE INTESTINE: SIGMOID COLON
S-shaped loop - variable in length, links descending colon & rectum.
Extends from pelvic brim to 3rd segment of sacrum where it joins rectum
• Has head, body, tail
• Pancreatic duct
penetrates wall of
duodenum
• Pancreas is an
exocrine & endocrine
organ
PANCREAS
Exocrine functions:
* Secreting H2O
* Secretes ions
* Digestive enzymes into small intestine