Abdomen - m-learning.zju.edu.cn

Abdomen - m-learning.zju.edu.cn

Regional anatomy Anterolateral Abdominal Wall The The Anterolateral Anterolateral Abdominal Abdominal Wall

Wall Superficial structures Deep structures 1.Skin 2.Superficial fascia 3.Deep fascia and muscles

4.Transverse fascia 5.Extraperitoneal fascia 6.Parietal fascia

The layers of the anterolateral abdominal wall .The superficial structures Surface Features of Skin

Superficial fascia Surface Features of the Abdomen Superficial fascia Divisions below umbilicus Superficial fatty layer (Campers)

Membranous layer (Scarpas) Superficial vessels and cutaneous nerves Arteries Superficial epigastric a. Superficial iliac

circumflex a. Veins Thoracoepigastric v. Superficial epigastric v. Cutaneous nerves Anterior and lateral cutaneous n. of lower six thoracic

Iliohypogastric n. (first lumb nerves) The ilioinguinal and the lower abdominal flaps .The Deep Structures Muscular layer

Vessels, lymph and nerve Transversalis fascia Extraperitoneal fascia Parietal peritoneum Muscles of abdomen Anterolateral group

obliquus externus abdominis oblequus enternus abdominis

transversus abdominis rectus abdominis Posterior group Quadiatus

lumborum Psoas major Obliquus externus absominis General direction of fibers: downward, forward and

medially (run down and inward) Structures Inguinal ligament Lacunar ligament pectineal ligament Superficial inguinal ring triangular-shaped

defect in aponeurosis of obliquus externus abdominis above pubic tubercle Inguinal ligament pectineal ligament

Superficial inguinal ring Lacunar ligament Superficial inguinal ring Obliquus internus abdominis

Deep to obliquus externus abdominis General direction of fibres: upwards, forwards and medially Transversels abdominis Deep to obliquus

internus inguinal ligament lacunar ligament pectineal ligament Inguinal falx : arch over spermatic cord, inserted with transverses abdominis fiber into medial part

of pecten of pubis Cremaster : around the spermatic cord and testis Inguinal falx Rectus abdominis Position: lie on to either of midline

Origin: pubic crest and symphysis Insertion: xiphoid and 5th7th costal cartilages Has 3-4 tendinous intersections linea semiluaris arcuate line Linea alba tendinous raphe between right and left recti from xiphoid to pubic symphysis.

Linea alba Deep vessels and nerves Arteres Superior and inferior epigastric arteris Lower posterior intercostal a. Subcostal a.

Four lumbar a. Nerves Intercostal n.(6-11) Subcostal n. Nerves Iliohypogastric n.

Ilioinguinal n. Genitofemoral n. Regional anatomy Sheath of rectus abdominis

Ant layer formed by fusion of aponeurosis 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 arcuate line The Inguinal Region Boundary Layers and characteristics

Inguinal canal Inguinal triangle Hernias Direct inguinal hernias Indirect inguinal hernias Femoralhernias Inguinal region Boundaries Inguinal ligament

Lateral margin of rectus abdominis A horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominis Inguinal canal Position: oblique passage, 4cm long, located

1.5cm above medial half of inguinal lig. Boundaries Ant wall Aponeurosis of obliquus externus

abdominis Obliquus internus abdominis (lateral third of wall) Posterior wall Transverse fascia Inguinal flax medially Roof arched lower

fibers of obliquus internus and transversua abdominis Floor inguinal lig Two openings Superficial inguinal ring

Deep inguinal ring defect in transverse fascia 1.5cm above midpoint of inguinal ligament Structures passing through the inguinal canal Spermatic cord and ilioinguinal nerve in males Round ligament of uterus and ilioinguinal

nerve in females 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 Triangle (of Hesselbach) Boundaries Inguinal ligament inferiorly Lateral border of rectus abdominis

medially Inferior epigastric artery laterally Inguinal Triangle Hesselbachs triangle

Indirect inguinal heinia and direcet inguinal heinia Direcet heinia Indirect inguinal ehinia

Hernias Hernias Hernias Layer ? Subcostal incision

Muscle-splitting incision Median or midline incision Left paramedian incision Transverse incision Suprapubic incision

Regional anatomy The peritoneum Ling Shucai .General features The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities

Parietal peritoneum lines the walls of the abdominal and pelvic cavities Visceral peritoneum covers the organs Peritoneal cavity the potential space between the parietal and visceral layer of peritoneum, in the mail, is a closed sac, but in the female, there is a communication

with the exterior through the uterine tubes, the uterus, and the vagina Function Secretes a lubricating serous fluid that continuously moistens the associated organs Absorb Support viscera

.The relationship between viscera and peritoneum Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera Intraperitoneal viscera Interperitoneal viscera

Retroperitoneal viscera Interperitoneal viscera . Formative formation by peritoneum The omentum

The mesenteries and mesocolons The ligaments

The peritoneal recesses, pouches, fossae and folds Omentum two-layered fold of peritoneum that extends from stomach to adjacent organs Lessor omentum

Greater omentum Lessor omentum Hepatogastric ligament extends from porta hepatis to lesser

curvature of stomach Hepatoduodenal ligament Extends from porta hepatis to superior part of

duodenum Contains common bile duct, proper hepatic a. and hepatic portal v. Omental foramen Behind the right border of

hepatoduodenal ligament Superior caudate lobe of liver Inferior superior part of duodenum Anterior hepatodudenal ligament Posterior peritoneum covering the inferior vena cava

Greater omentum four-layered fold of peritoneum, the anterior two layers descend from the greater curvature of stomach and superior part of duodenum and hangs down like an apron in front of coils of small intestine, and then

turns upward and attaches to the transverse colon. If an infection occurs in the intestine, plasma cells formed in the lymph nodes combat the infection and help prevent it from spreading to the peritoneum. Lessor omentum

Greater omentum Omental bursa Position situated behind the lesser omentum and stomach Walls Superior peritoneum which covers the caudate lobe of liver and

diaphragm Anterior formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum Inferior conjunctive area of anterior and posterior two layers of greater omentum

Posterior formed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland Left formed by the

spleen, gastrosplenic ligament and splenorenal ligament Right formed by omental foramen The Omental bursa

(lesser sac) communicates with the greater sac through the omental foramen. Mesenteries or mesocolons twolayered fold of peritoneum that attach part of the intestines to the posterior abdominal

wall The mesenteries and mesocolons Mesentery suspends the small intestine from the posterior abdominal wall Broad and a fan-shaped Consists of two peritoneal

layers Intestinal border folded, 7 m long Radix of mesentery 15 cm long Directed obliquely from left side of L2 to in front of right sacroiliac joint Mesoappendix

Triangular mesentery extends from terminal part of ileum to appendix Appendicular artery runs in free margin of the mesoappendix Transverse mesocolon a double fold of peritoneum which connects

the transverse colon to the posterior abdominal wall Sigmoid mesocolon inverted V-shaped, with apex located in front of left ureter and division of common iliac artery Ligaments two-layered folds of

peritoneum that attached the lesser mobile solid visera to the abdominal wall Ligaments of liver Falciform ligament of liver Coronary ligament Left and right triangular ligaments

Hepatogastric ligament Hepatoduodenal ligament Ligamentum teres hepatis Ligaments of spleen

Gastrosplenic ligament Splenorenal ligament Phrenicosplenic ligament Splenocolic ligament Ligaments of stomach Hepatogastric ligament Gastrosplenic ligament

Gastrophrenic ligament Gastrocolic ligament Gastropancrestic ligament The peritoneal recesses, pouches, fossae and folds Superior duodenal fold and recess Inferior duodenal fold and

recess Intersigmoid recess formed by the inverted V attachment of sigmoid mesocolon The peritoneal recesses, pouches, fossae and folds Superior duodenal fold and recess

Inferior duodenal fold and recess Intersigmoid recess formed by the inverted V attachment of sigmoid mesocolon Retrocecal recess in which the appendix

frequenty lies Hepatorenal recess lies between the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of the peritoneal cavity when the

subject is supine Folds and fossas of anterior abdominal wall Median umbilical fold contain the remnant of urachus (median umbilical ligaments) Medial umbilical fold contains remnants of

the umbilical arteries (medial umbilical ligaments) Lateral umbilical fold contains the inferior epigastric vessels Supravesical fossa Medial inguinal fossa Lateral inguinal fossa

Pouches In male - rectovesical pouch In female Rectouterine pouch between rectum and

uterus Vesicouterine pouch between bladder and uterus .Peritoneal subdivisions The transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic

compartments. Supracolic compartments (subphrenic space) lies between diaphragm and transverse colon and transverse mesocolon Infracolic compartments. lies below the transverse colon and transverse mesocolon Subphrenic Space

Suprahepatic recess Left suprahepatic recesses left anterior suprahepatic spaces left posterior suprahepatic spaces Right suprahepatic recesses right anterior suprahepatic spaces right posterior suprahepatic spaces bare area of live (extraperitoneal space) Infrahepatic recess Right infrahepatic recesses (hepatorenal

recess) Left infrahepatic recesses left anterior infrahepatic space left posterior infrahepatic space ( Suprahepatic recess lies between the diaphragm and live the falciform ligament divides it into right and left suprahepatic recesses Left suprahepatic recesses

left anterior suprahepatic spaces left posterior suprahepatic spaces Right suprahepatic recesses right anterior suprahepatic spaces right posterior suprahepatic spaces bare area of live (extraperitoneal space)

Infrahepatic recess lies between the live and transverse colon and transverse mesocolon the ligamentum teres hepatic divides it into right and left infrahepatic recesses Right infrahepatic recesses (hepatorenal recess ) Left infrahepatic recesses

left anterior infrahepatic space left posterior infrahepatic space Infracolic compartments lies below the transverse

colon and transverse mesocolon Right paracolic sulcus lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection between the pelvic and the upper abdominal region. Left paracolic sulcus lies lateral to the descending colon.

It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm. Right mesenteric sinus triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and

transverse mesocolon Left mesenteric sinus lies between root of mesentery, descending colon, right 1/3 of transverse colon and transverse mesocolon, its widens below where it is continuous with the cavity of the pelvis

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