Abdomen 3

This presentation covers the 3rd quarter of Anatomy of the Abdomen

Transcript

1. LIVER (Page 182)
2. Shape &Size
3. Site
4. Lobes of the liver: A- Anatomical: - Left lobe. - Right lobe. -Caudate lobe. -Quadrate lobe. By attachments of falciform ligament, fissure of ligamentum teres and fissure of ligamentum venosum.
5. Anatomical Divisions
6. Falciform lig. Containg
7. Fissure of lig. venosum Fissure of lig. teres Left lobe
8. Surgical & Physiological Divisions (Page 183)
9. Middle hepatic vein 1 2 3 4 5 6 7 8
10. Surfaces, Border & Relations (Page 187)
11. Anterior, Superior and Right Relations
13. Posterior & Inferior Relations
14. Posterior Surface 1- Back of left lobe. 2- Fissure of ligamentum venosum. 3- Cudate lobe. 4- Fossa for inferior vena cava. 5- Back of right lobe.
16. Groove for esophagus Fissure for lig. venosum Caudate lobe I.V.C. Upper layer of coronary lig. RT triangular lig. Lower layer of triangular lig. Gall bladder Quadrate lobe Fissure for lig. teres Omental tuberosity Gastric area Bare area Porta hepatis Papillary process Caudate process Inferior surface of RT lobe
18. Inferior (Visceral) Surface
20. Esophagus Stomach Lesser omentum Pyloro-duodenal junction Area for transverse colon Gall bladder 2nd part of duodenum Rt. Colic flexure Rt. kidney Rt. Suprarenal gland Dr. Sherif Fahmy
21. Peritoneal Relations (page 191)
22. Areas not covered with peritoneum: 1- Bare area of the liver. 2- Fossae for gall bladder & for IVC. 3- Porta hepatis. Peritoneal folds related to liver: 1- Falciform ligament. 2- Coronary ligament. 3- Triangular ligaments. 4- Lesser omentum (Page 82)
23. Falciform Ligament (Page 193)
24. Falciform ligament
25. Dr. Sherif Fahmy
26. Coronary Ligament (Page 195)
27. Dr. Sherif Fahmy
28. Dr. Sherif Fahmy
29. Triangular Ligaments (Page 195)
30. Dr. Sherif Fahmy
31. Lesser Omentum
32. Fissure of ligamentum venosum Lesser omentum Porta hepatis Dr. Sherif Fahmy
33. Lesser omentum Dr. Sherif Fahmy
34. Subphrenic Spaces (Page 86)
35. Falciform ligament
36. Dr. Sherif Fahmy
37. Dr. Sherif Fahmy
39. Fissures of the Liver (Page 185) 1- Porta hepatis. 2- Fissure of ligamentum venosum. 3- Fissure of ligamentum teres.
41. Ligaments of the Liver: (Page 186) A- Obliterated vascular ligaments: 1- Ligamentum teres. 2- Ligamentum venosum. B- Peritoneal ligaments: 1- Coronary ligament. 2- Right & left triangualr ligaments. 3- Lesser omentum. 4- Falciform ligament.
42. Surface Anatomy (Page 196)
43. 5th intercostal space Xiphisternal junction Rt. 5th rib Rt. 7th rib 1 cm below the costal margin Rt 9th costal cartilage Transpyloric plane Left 8th costal cartilage
44. Blood Supply of Liver (Page 197)
45. Portal Vein
46. Hepatic artery Portal vein Liver sinusoid Central vein Liver cells
47. Hepatic Artery
49. Lymphatic Drainage:(Page 197) A- Lymph vessels: Superficial & Deep. B- Lymph nodes: 1- Lateral diaphragmatic nodes. 2- Paracardial nodes. 3- Parasternal nodes. 4- Hepatic nodes. 5- Coeliac nodes.
51. Factors supporting liver in position:(Page 198) 1- Hepatic veins. 2- Intra-abdominal pressure. 3- Tone of anterior abdominal muscles. 4- Peritoneal folds and ligaments.
52. Extra-hepatic Biliary Passage A. Duct system for transmission of bile. B. Gall bladder for storage of bile.
53. Hepatic & Cystic Ducts
54. Hepatic Artery Common Bile duct Common hepatic duct Gastro- duodenal art. Cystic duct
55. Common Bile Duct (Page 200)
56. Hepatic Artery Common Bile duct Common hepatic duct Gastro- duodenal art. Cystic duct
60. Lesser omentum Common bile duct Hepatic artery Portal vein Opening of lesser sac
61. Main pancreatic duct Infra-duodenal common bile duct Ampulla of Vater Sphincter of Oddi in the major duodenal papilla Common hepatic duct Cystic duct Left hepatic duct Right hepatic duct Supraduodenal bile duct Retro-duodenal duct
62. Gall Bladder
63. Site, Shape and Size
64. Fundus of gall bladder
65. Gall bladder Neck of gall bladder Cystic duct
66. Surface Anatomy
67. Transpyloric plane Rt Linea semilunaris Murphy’s point
68. Functions of Gall Bladder 1- Concentration of bile. 2- Storage of bile.
69. Peritoneal Covering of Gall Bladder
70. Fundus of gall bladder
71. Parts & Relations of Gall Bladder
72. Fundus Body Hartman’s pouch of neck Cystic duct Neck
73. Fundus of gall bladder Transverse colon
74. Neck of gall bladder 2nd inch of 1st part of duodenum Cystic artery Hepatic artery Body of Gall bladder 2nd part of duodenum
75. Blood Supply of Gall Bladder
76. Neck of gall bladder Cystic duct 2nd inch of 1st part of duodenum Cystic artery Common hepatic duct Common bile duct Hepatic artery Gall bladder Calot’s triangle
77. Applied anatomy: Cholecystitis: pain in right hypochondrium and radiate to: ➢The tip of right shoulder because it receives sensory fibers from right phrenic (C3,4,5) while the right shoulder receives sensory fibers from lateral supraclavicular nerve (C3,4). ➢At the back below scapula because pain is transmitted through greater splanchnic nerve (T5 – 9). Stone in Hartman’s pouch: Can obstruct neck of the gall bladder or common hepatic duct leading to obstructive jaundice. Rare gall bladder gangrene: because it has arterial supply.
78. Portal Vein (Page 155)
79. Portal Circulation It is the venous drainage of stomach, spleen, pancreas and intestine. Portal vein Systemic veins Portal vein and tributaries. IVC & SVC and tributaries No valves May contain valves. Starts by tributaries and ends by divisions Starts by tributaries and ends by larger vein. Has 2 sets of capillaries One set of capillaries Blood contains absorbed food. Blood contains waste products. Blood is incompletely deoxygenated blood. Blood is completely deoxygenated blood. Blood pressure is higher. Blood pressure is lower.
80. Course of Portal Vein
81. Splenic vein Superior mesenteric vein Beginning of portal vein Ends in porta hepatis Neck of pancreas (cut) Portal vein (3 inches X 12 mms)
82. Relations
83. First part of duodenum Hepatic artery Bile duct Neck of pancreas Lesser omentum Anterior relations
84. Hepatic artery Common bile duct Free margin of lesser omentum Opening of lesser sac
85. Caudate process Inferior vena cava Deep (Posterior) relations
86. Inferior vena cava Portal vein
87. Tributaries
88. Splenic vein Superior mesenteric vein Left gastric vein Right gastric vein Cystic vein Paraumbilical vein
89. Porto-systemic Anastomosis
92. Splenic Vein (Page 158)
93. Superior mesenteric vein Splenic vein Beginning of portal vein Splenic veins Body of pancreas Neck of pancreas
94. Splenic vein Splenic veins Short gastric veins Left gastro-epipolic vein Pancreatic veins Inferior mesenteric vein
95. Superior Mesenteric Vein (Page 160)
96. Ileocolic vein Superior mesenteric artery Neck of pancreas Splenic vein Portal vein
97. Jejunal veins Ileal veins Ileocolic vein Right colic vein Middle colic vein Pancreatico-duodenal veins Right gastro-epiploic vein Superior mesenteric vein
98. Kidney
99. T12 L3 Site -It lies on the posterior abdominal wall from T12 to L3. -Left kidney reaches 11th rib while right kidney reaches 11th intercostal space.
100. Transpyloric plane (L1) Midline 2 inches 2 inches -Hilum is 2 inches away from midline at transpyloric plane -Upper end is 2 inches above hilum and 1 inch from midline. -Lower end is 2 inches below hilum and 3 inches from midline. -Long axis is directed downwards and laterally. Size: 4 X 2 X1 inches
101. External Features
102. Hilum External features: - Its shape is bean shape. - It has: -Two ends (upper & lower). -Two surfaces (anterior & posterior). -Two borders (lateral & medial). - Hilum -is concave and present in the middle of the medial border. -It contains renal vein, renal artery and pelvis of ureter ( from anterior to posterior) -Sinus is the space that lies inner to the hilum and deficient of renal tissue but contains segmental branches of renal artery and pelvis of ureter. -Transpyloric (L1) plane passes through upper part of right hilum and lower part of left hilum. - It is lined with fibrous capsule and perinephric fat.
103. Sinus of the kidney
104. Relations of Kidneys
105. Diaphragm Medial arcuate lig. Lateral arcuate lig. Psoas major m. Quadratus lumborum m. Transversus abdominis m. Subcostal vessels & nerve Ilio-hypogastric n. Ilio-inguinal n. Posterior Relations
107. Anterior Relations
108. Anterior relations of left kidney Body of pancreas Splenic artery Left suprarenal gland Descending colon Ascending branch of superior left colic artery Coils of jejunum Area for spleen Area for stomach & lesser sac
109. Anterior relations of right kidney Right supra- renal gland 2nd part of duodenum Right colic flexure Ascending colon Ascending branch of right colic artery Coils of jejunum Area for Rt lobe of liver
110. Coverings of the Kidney
111. Anaterior Posterior LS Kidney & its coverings
112. Surface Anatomy
113. On the anterior abdominal wall
114. On the posterior abdominal wall
115. Stability of Kidney: 1- Its position in paravertebral gutter. 2- Coverings of the kidney. 3- Intra-abdominal pressure. 4- Apposition of surrounding organs. Applied Anatomy ➢ Renal pain is a result of stretch of renal capsule or spasm of smooth muscle of renal pelvis of the ureter. ➢ Renal pain is transmitted along sympathetic supply (T10 – T12), so pain is felt in the flanks and down to lower abdominal wall.
116. Dr. Sherif Fahmy
117. Blood Supply of Kidney (Page 216)
118. Arterial (Renal & Accessory Renal Arteries)
121. Venous Drainage
123. Lymphatic Drainage
125. Ureter (Page 219)
128. Relations of Ureter
129. A- Abdominal Part
134. B- Pelvic Part
138. Constrictions of Ureter
140. Blood Supply of Ureter
142. Nerve Supply of Ureter
144. Surface Anatomy of Ureter
146. Applied Anatomy - Stone ureter is usually impacted at site of constrictions. - Ureteric pain from loin to groin (due to sympathetic supply comes from T11 – L2 Nerves). - Identification of stone ureter in X-ray.
147. X-Ray of Stone Ureter
149. Suprarenal Gland
150. Rt. Suprarenal gland Left suprarenal gland
151. Relations of Suprarenal Glands
152. Anterior relations of left suprarenal
153. Anterior relations of right suprarenal gland
154. Posterior relations
155. Blood Supply
156. Superior suprarenal artery Middle suprarenal artery Inferior suprarenal artery Sprarenal vein
157. Vessels of Posterior Abdominal Wall
158. Abdominal Aorta (Page 223)
159. Course & Relations
160. Thoracic aorta Abdominal aorta
161. Abdominal aorta
162. Relations
163. Posterior Relations
164. Abdominal aorta Upper 4 lumbar vertebrae
165. Left 3rd & 4th lumbar veins Inf. Vena cava
166. Anterior Relations
168. Abdominal Aorta Splenic vein Left renal vein Head of pancreas (cut) Superior mesenteric a. 3rd part of duodenum Inferior vena cava
170. Side Relations
171. Crura of Diaphragm
172. Sympathetic chain
173. Inferior vena cava
174. Para-aortic lymph nodes Cisterna chyli
175. Branches
176. Coeliac artery Superior mesenteric artery Inferior mesenteric artery Common iliac artery Renal artery Middle suprarenal artery Inferior phrenic Gonadal artery Ventral single arteries Side paired branches
180. Surface Anatomy
182. Common Iliac Artery (page 224)
183. Common iliac artery External iliac artery Internal iliac artery Lumbosacral junction Begins opposite disc L4/5
184. Relations of Common Iliac artery
185. Sympathetic chains Body of L5 Sympathetic fibers from aortic plexus to superior hypogastric plexus Posterior Relations Anterior relations Inferior mesenteric artery crosses infront left common iliac artery
186. Inferior mesenteric artery Beginning of IVC is behind Rt common iliac artery
187. External Iliac Artery (Page 236)
188. Lumbosacral junction Deep to inguinal ligament at mid- inguinal point Femoral artery Course of Ext. Iliac Artery External iliac artery
189. Deep circumflex iliac artery Inferior epigastric artery Branches of Ext. Iliac Artery
190. External iliac artery Deep circumflex iliac artery Inferior epigastric artery Cremastric artery Pubic branch Obturator artery Pubic branch of obturator artery ASIS Branches of Inferior Epigastric Artery
191. External iliac a. Inferior epigastric a. Fascia transversalis Cremastric a. Pubic branch Obturator a. Pubic branch Course & beanches of Inferior epigastric artery Inner Aspect of Anterior Abdominal wall
192. 4 Lumbar arteries Median sacral artery Branches from back of Aorta
193. Gonadal Arteries (Page 222)
194. Right gonadal a. Left gonadal a.
195. Inferior Vena Cava (Page 228)
196. Begins opposite L5 Opening in central tendon of diaphragm at T8 (1 inch to the Rt of midline)
197. Relations 1- Anterior. 2- Posterior. 3- Right. 4- left.
198. Anterior Relations
199. Rt common iliac artery Superior mesenteric vessels in the root of mesentery 3rd part of duodenum &right gonadal vs Head of pancreas & common bile duct 1st part of duodenum Portal vein
200. Common bile duct Hepatic artery Portal vein Opening of lesser sac Right lobe of liver
201. Posterior Relations
202. Rt. Renal artery Rt. Crus of diaphragm Middle suprarenal art. Rt, suprarenal gland Inferior phrenic artery Lower 3 lumbar vertebrae Rt. Psoas major muscle
203. Cisterna chyli Sympathetic chain Right margin of psoas major m. Lumbar arteries
204. Right and Left Relations
205. Rt. ureter Rt. Kidney 2nd part of duodenum Rt lobe of liver Right Relations
206. Abdominal aorta Left Relations Fibers from right crus of diaphragm
207. Tributaries
208. Common iliac vein Renal vein Rt. Gonadal vein Rt. Suprarenal vein Phrenic vein Hepatic veins
209. 3rd & 4th lumbar veins Left gonadal vein Left suprarenal vein
210. Surface Anatomy
211. Inertubercular plane (L5), one inch to the right Rt 6th costal cartilage
212. Anastomosis Between Superior & Inferior Vena Cava (Page 230) A- At posterior abdominal wall: 1- Azygos vein. 2- Inferior hemiazygos vein. 3- Vertebral venous plexuses. B- At anterior abdominal wall: 1- Superior & inferior epigastric veins. 2- Thoraco-epigastric vein.
213. Lymph Drainage of Abdomen (Page 231)
214. Inferior mesenteric nodes Inferior mesenteric nodes Ext. iliac nodes Int. iliac nodes Common iliac nodes Para-aortic nodes Lumbar lymph trunk Intestinal lymph trunk Coeliac nodes Cisterna chyli
215. Cisterna Chyli Cisterna chyli 2 Lumbar lymph trunk Intestinal lymph trunk
216. Lumbar Plexus (Page 245)
217. Site of Lumbar Plexus
218. Dr. Sherif Fahmy Psoas major m. Lumbar plexus Roots of lumbar plexus: Anterior primary rami of upper 4 lumbar nerves
219. Formation of Lumbar Plexus
220. L1 L2 L3 L4 Ilio-hypogastric n. Ilio-inguinal n. Genito-femoral n. Lateral cutaneous nerve of thigh Femoral n. Accessory obturator n. Obturator n. Lumbo-sacral trunk L5 Dr. Sherif Fahmy Posterior (dorsal division) Anterior (ventral division)
221. Branches of Lumbar Plexus and its Relation to Psoas Major Muscle
222. Ilio-hypogastric n. Ilio-inguinal n. Lateral cutaneous nerve of thigh Femoral n. Genito-femoral n. Obturator n. Lumbo- sacral trunk Psoas major m. Iliacus Dr. Sherif Fahmy
223. Lumbar Part of Sympathetic Chain (Page 247)
224. Lumbar part of Sympathetic chain Medial arcuate ligament Common iliac artery Sacral part of sympathetic chain
225. Branches of Lumbar Sympathetic Chain Rami communicants: 1- White ramus communicant: from upper 2 ganglia. 2- Grey ramus communicants: from 4 ganglia. Splanchnic: 1- Upper 2 ganglia gives splanchnic branches to aortic plexus. 2- Lower 2 ganglia gives splanchnic branches to superior hypogastric plexus. Vascular: to abdominal aorta.
226. Autonomic Plexuses (Page 248)
227. Autonomic Plexus 1- Coeliac. 2- Aortic (Intermesenteric). 3- Superior hypogastric. 4- Inferior hypogastric (in the pelvic cavity).
228. Coeliac ganglia Coeliac plexus Aortic (intermesenteric) plexus Superior hypogastric plexus Inferior hypogastric plexus
229. Coeliac Aortic (Inter- mesenteric) Superior hypogastric Inferior hypogastric Site Sympathetic part Parasympathetic part Branches -Around coeliac trunk. - Infront abdominal aorta between origin of 2 mesenteric arteries -Below bifurcation of aorta infront L5 vertebra. - In pelvic cavity on both sides of rectum and urinary bladder -Greater and lesser splanchnic nerves relay in coeliac and aortico renal ganglia. -Postganglionic fibers join the coeliac plexus -From coeliac plexus. -Splanchnic nerves from L1 & L2 sympathetic ganglia. -From aortic plexus. -From splanchnic nerves of L3 & L4 ganglia. -From superior hypogastric plexus. -From splanchnic nerves S1 & S2 Vagus nerve Pelvic splanchnic nerve (S2,3,4) -Plexuses around branches of coeliac trunk. -Plexus around superior mesenteric artery. -Plexus around renal artery. -To aortic plexus. -Plexus around inferior mesenteric artery. -Gonadal plexus. -Iliac arteries plexus. -To superior hypogastric plexuses. -Gonadal plexus. -Iliac arteries plexus. -To inferior hypogastric plexuses. -Pelvic viscera plexuses (rectum, urinary bladder. Prostate and utero- vaginal.