Abdomen 4

This presentation shows the 4th quarter of Anatomy of the Abdomen

Transcript

1. Spleen
2. Site, Size
3. Spleen Diaphragm Stomach
4. Spleen Stomach Diaphragm 9th rib 10th rib 11th rib
5. Surface Anatomy
6. 1.5 inch Mid-axillary line
7. Peritoneal Covering
8. Spleen
9. Spleen is completely covered with peritoneum except hilum that gives attachment to: -Gastrosplenic lig. -Lienorenal lig. Gastrosplenic lig. Lienorenal lig.
10. Features of Spleen It has: 1- Two Ends: Anterior & Posterior. 2- Two Borders: Upper & Lower. 3- Two Surfaces: Diaphragmatic & Visceral.
11. Posterior (medial) end Anterior (lateral) end Upper border Lower border
12. Surfaces of the Spleen Visceral Surface Diaphragmatic Surface Hilum
13. Relations A- Diaphragmatic surface. B- Visceral surface.
14. Spleen Diaphragm 9th rib 10th rib 11th rib Diaphragmatic relations
15. Hilum of Spleen Left colic flexure Tail of pancreas Stomach Visceral Relations Left kidney
16. Gastric impression Renal impression for left kidney Colic impression for left colic flexure Impression of tail of pancreas
17. Blood Supply
18. Splenic artery Celiac trunk 4-5 Terminal branches
19. Splenic vein Superior mesenteric vein Portal vein
20. Lymph Drainage ➢Red bulbs of spleen has no lymphatics. ➢Few lymphatics from the capsule and trabeculae are drained to pancreatico- splenic nodes.
21. Pancreatico-splenic lymph nodes Coeliac lymph nodes
22. Factors supporting spleen in position 1- Peritoneal ligaments. 2- Intra-abdominal pressure. 3- Contact with surrounding organs.
23. Functions of Spleen 1- Store of blood and iron. 2- Destruction of old red blood cells. 3- Formation of red blood cells during intra-uterine life till the 5th month of intrauterine life.
24. Applied Anatomy 1- Common causes of splenic enlargement? 2- Spleen can be felt below costal margin after being enlarged 3 times its normal size. 3- Spleen enlarge downwards and to the right due to presence of phrenico-colic ligament.
25. Pancreas
26. Site of Pancreas 2nd part of duodenum Spleen
27. Parts of Pancreas Head Uncinate process Neck Body Tail Dr. Sherif Fahmy
28. Peritoneal Coverings
29. Relations to peritoneum Transverse colon Transverse mesocolon
30. Relations of Pancreas
31. 1- Relations of Head
32. Transverse colon Superior mesenteric vessels Dr. Sherif Fahmy
33. IVC Common bile duct Right renal vein Deep surface of pancraes
34. Head of panceas Duodenum Superior pancreatico- duodenal vessels Inferior pancreatico- duodenal vessels
35. 2-Relations of Neck of Pancreas
36. Pyloro-duodenal junction
37. Portal vein Splenic vein Superior mesenteric vein Neck of pancreas (cut)
38. 3- Relations of the Body The body of pancreas is triangular in cross section. It has 3 surfaces & 3 borders: Surfaces: - Anterior. - Posterior. - Inferior. Borders: - Anterior. - Upper. - Lower
39. Posterior surface Inferior surface Upper border Anterior border Inferior border
40. Omental tuberosity Transverse mesocolon Celiac trunk Celiac lymph nodes Splenic artery Pancreatico-splenic lymph nodes Duodeno-jujenal flexure Coils of jujenum Left colic flexure
41. Abdominal aorta Superior mesenteric artery Splenic vein Left renal vein Left crus of diaphragm Left sympathetic chain Left psoas major muscle Left kidney Left suprarenal gland
42. 4- Relations of the Tail
43. Lieno-renal lig. Tail of pancreas Splenic vessels
44. Pancreatic Duct
45. Main pancreatic duct Common bile duct Ampulla of Vater Sphincter of Oddi in the major duodenal papilla Accessory pancreatic duct Minor duodenal papilla
46. Blood Supply of Pancreas
47. Celiac trunk Splenic artery Gastro-duodenal a. Superior mesenteric artery Inferior pancreatico- duodenal artery Superior pancreatico- duodenal artery
48. Splenic vein Superior & inferior pancreatico- duodenal veins Superior mesenteric vein Portal vein
49. Lymph Drainage
50. Pancreatico-splenic lymph nodes Celiac lymph nodes Superior mesenteric lymph nodes
51. Applied Anatomy Cancer head: may lead to obstruction of: 1- Common bile duct: leads to jaundice. 2- Inferior vena cava: Edema in lower limb. 3- Portal vein: Portal hypertension. 4- Pyloric end: leads to pyloric stenosis. 5- Duodenum: Duodenal obstruction. Pancreatic pain: Felt in epigastric region, referred to back. Relieved by leaning forward. Duodenal ulcer: May be complicated by erosion of pancreas.
52. Arteries of the Gut
53. Abdominal aorta Coeliac artery (upper border of L1) Superior mesenteric artery (lower border of L1) Inferior mesenteric artery (L3)
54. 1- Coeliac Trunk (Page 139)
55. Level & Relations of Coeliac Trunk
56. Lesser omentum & lesser sac Coeliac trunk (at lower border of T12 or upper border of L1) Median arcuate ligament Anterior Relations Superior Relations
57. Crura of diaphragm Coeliac ganglia Coeliac trunk Lateral Relations
58. Coeliac ganglia Omental tuberosity of pancreas Lateral & Inferior Relations
59. Branches of Coeliac Trunk 1- Celiac trunk. 2- Splenic artery. 3- Hepatic artery.
60. 1- Left Gastric Artery
61. Coeliac trunk Left gastric artery Esophageal branch
62. 2- Splenic Artery
63. Coeliac trunk Splenic artery Pancreatic branches Arteria pancreatica magna
64. Coeliac trunk Splenic artery 5 terminal splenic branches (end arteries) Short gastric arteries Left gastro-epiploic artery Posterior gastric 50 %
65. 3- Hepatic Artery
66. Coeliac trunk Common hepatic artery Right gastric artery Gastroduodenal artery Supraduodenal artery (50 %) Right gastro-epiploic a. Superior pancreatico- duodenal artery Hepatic artery proper
67. Coeliac trunk Hepatic artery Hepatic artery proper Cystic artery Left & right divisions of hepatic artery proper
68. Superior Mesenteric Artery (Page 146)
69. Course & Relations
70. Superior mesenteric a. Superior mesenteric vein 3rd part of duodenum Body of pancreas
71. Splenic vein Left renal vein Head of pancreas (cut) Superior mesenteric a. 3rd part of duodenum Inferior vena cava
72. Branches of Superior Mesentric Artery 1- Inferior pancreatico-duodenal. 2- Jujenal & ileal 3- Middle colic. 4- Right colic. 5- Ileocolic.
73. Superior mesenteric a. Inferior pancreatico- duodenal a.
74. Middle colic Right colic Ileocolic Superior mesenteric artery Jejunal arteries Ileal arteries
76. Inferior Mesenteric Artery (Page 152)
77. Abdominal aorta Common iliac artery Coeliac artery Superior mesenteric artery Inferior mesenteric artery
78. Inferior mesenteric a. Superior rectal a.
79. Branches of inferior mesenteric artery: 1- Superior left colic. 2- Inferior left colic (sigmoidal). 3- Superior rectal artery.
81. Marginal Artery
83. Perineum (Page 104- pelvis book)
84. Dr. Sherif Fahmy
85. Dr. Sherif Fahmy
86. Ischio-rectal Fossa (Page 112)
87. Dr. Sherif Fahmy
88. Dr. Sherif Fahmy
89. Dr. Sherif Fahmy
90. Internal Pudendal Artery & Pudendal Nerve (Page 115)
93. Dr. Sherif Fahmy
94. Deep Perineal Pouch (Page 124)
95. Dr. Sherif Fahmy
96. Dr. Sherif Fahmy
97. Dr. Sherif Fahmy
98. Superficial Perneal Pouch (Page 127)
99. Dr. Sherif Fahmy
100. Dr. Sherif Fahmy
101. Female superficial pouch Dr. Sherif Fahmy
102. MUSCLES OF POSTERIOR ABDOMINAL WALL
103. Diaphragm (Page 233)
104. Attachments of Diaphragm
105. Origin of Diaphragm
106. Xiphoid process Lower 6 ribs & costal cartilages Right crus of diaphragm Left crus of diaphragm Median arcuate ligament Medial arcuate ligament Lateral arcuate ligament Psoas major muscle Quadratus lumborum Central (trifoliate) tendon
107. Insertion of Diaphragm & Defects in the Diaphragm
108. Sternal origin Costal origin Vertebral origin Anterior defect (foramen of Morgagni) Posterior defect (foramen of Bockdalek – vertebrocostal triangle) Central tendon Median part (folium) of central tendon Lateral parts (folia) of central tendon
109. Pericardium Pleura Peritoneal canal Pleuro-peritoneal membrane Pleuro-pericardial membrane Reason of formation of vertebro-costal defect
110. Major Openings of Diaphragm
111. Vena caval opening (1 inch to the right of midline at T8) IVC Right phrenic nerve Esophageal opening (1 inch to the left of midline at T10) Esophagus Anterior & posterior vagal trunks Aortic opening of diaphragm (midline at T12) Aorta Thoracic duct
112. Minor openings of diaphragm ➢Superior epigastric and musculophrenic arteries. ➢Lower 5 intercostal nerves and subcostal nerve. ➢Subcostal vessels. ➢Inferior hemiazygos vein. ➢Splanchnic nerves and sympathetic chain.
113. Arterial supply of diaphragm ➢Superior phrenic artery from descending aorta. ➢Inferior phrenic artery from abdominal aorta. ➢Musculophrenic artery. ➢Lower posterior intercostal arteries. ➢Pericardiacophrenic artery.
114. Applied anatomy Diaphragmatic hernia: A- Hiatus hernia: through esophageal opening. B- Hernia of Bockdalk: between vertebral and costal origin of diaphragm. C- Hernia of Morgagni: between sternal and costal origin of diaphragm.
115. Psoas Major Muscle (Page 239)
116. T12 Lumbar vertebrae & intervertebral discs Transverse processes of lumbar vertebrae
117. Iliac fossa of hip bone Lesser trochanter Ala of sacrum Inguinal lig.
118. Psoas Major Muscle
119. Psoas major m. T12 Lumbar vertebrae Ilio-psoas tendon to lesser trochanter & 1 inch below Inguinal lig.
120. Lumbar arteries
121. Relations of Psoas Major Muscle ➢Anterior. ➢Posterior. ➢Lateral. ➢Medial.
122. Anterior Relations
123. Right kidney 2nd part of duodenum 3rd part of duodenum Ureter Gonadal artery Genito-femoral nerve 4th part of duodenum
124. Descending colon Root of mesentery of small intestine & superior mesenteric vessels
125. Lateral & Posterior Relations
126. Quadratus lumborum Ilio-hypogastric nerve Ilio-inguinal nerve Iliacus muscle Lateral cutaneous nerve of thigh Femoral nerve Quadratus lumborum muscle Iliac crest Iliacus muscle Lumbar plexus and transverse processes of lumbar vertebrae Posterior Relations Lateral Relations
127. Medial Relations
128. Inferior vena cava Abdominal aorta Common iliac arteries
129. Diaphragm Transversus abdominis Quadratus lumborum Iliacus Psoas major Psoas minor
130. Relations of Psoas Major in the Femoral Triangle
131. Femoral nerve Psoas major Iliacus m. Femoral vessels inside femoral sheath Inguinal ligament Pectineus m.
132. Quadratus Lumborum (Page 242)
135. Quadratus lumborum
136. Psoas Minor (Page 243)
137. Psoas minor muscle
138. THORACO-LUMBAR FASCIA (Page 257)