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Abdomen 3

Abdomen 3

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

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Dr.Sherif Fahmy

August 13, 2019
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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

  12. None
  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.
  15. None
  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
  17. None
  18. Inferior (Visceral) Surface

  19. None
  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

  38. None
  39. Fissures of the Liver (Page 185) 1- Porta hepatis. 2-

    Fissure of ligamentum venosum. 3- Fissure of ligamentum teres.
  40. None
  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

  48. None
  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.
  50. None
  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
  57. None
  58. None
  59. None
  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

  90. None
  91. None
  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
  106. None
  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)

  119. None
  120. None
  121. Venous Drainage

  122. None
  123. Lymphatic Drainage

  124. None
  125. Ureter (Page 219)

  126. None
  127. None
  128. Relations of Ureter

  129. A- Abdominal Part

  130. None
  131. None
  132. None
  133. None
  134. B- Pelvic Part

  135. None
  136. None
  137. None
  138. Constrictions of Ureter

  139. None
  140. Blood Supply of Ureter

  141. None
  142. Nerve Supply of Ureter

  143. None
  144. Surface Anatomy of Ureter

  145. None
  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

  148. None
  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

  167. None
  168. Abdominal Aorta Splenic vein Left renal vein Head of pancreas

    (cut) Superior mesenteric a. 3rd part of duodenum Inferior vena cava
  169. None
  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
  177. None
  178. None
  179. None
  180. Surface Anatomy

  181. None
  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.