Abdomen 2 - Speaker Deck

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Small Intestine 1- Duodenum. 2- Jejunum. 3- Ileum.

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Duodenum Jujenum Ileum

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Duodenum (Page 111)

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General Features Site: Epigastric and umbilical region. Length: 10 inches (25 cm or 12 finger breadth). Shape: C-shaped. Parts: 1st (2 inches), 2nd (3 inches(, 3rd part (4 inches) & 4th part (1 inch). Peritoneal coverings: 1st inch like stomach while the rest is retroperitoneal.

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Beginning, Parts & End

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Pyloro-duodenal junction (L1)

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Dudo-jujenal flexure Suspensory lig. Of Trietz Right crus of diaphragm

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Duodeno- jejunal flexure Body of pancreas

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Directions & Level of Parts of Duodenum

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1st 2nd 3rd 4th Dr. Sherif Fahmy

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Peritoneal Coverings

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Lesser omentum Opening of lesser sac Greater omentum

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Retro- peritoneal parts bare areas

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Duodenal Folds & Recesses (Page 91)

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Superior fold Inferior fold Para- duodenal fold Retrro-duodenal recess Inferior mesenteric vein

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Relations of Duodenum

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Rt. kidney Rt. Psoas major m. Ureter Inf. Vena cava Abdominal aorta Lt. psoas major

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Head of pancreas Neck of pancreas Portal vein Quadrate lobe Gall bladder

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Relations of first part

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Upper & Anterior Relations of 1st part Quadrate lobe Neck of Gall bladder Lesser omentum Opening of lesser sac Greater omentum

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Quadrate lobe Neck of Gall bladder Anterior Relations of the 1st part

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Portal vein Neck of pancreas Posterior & Lower Relations of 1st inch Head of pancreas

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1st 2nd 3rd 4th Common bile duct Gastroduodenal art Posterior Relations of 2nd inch of 1st part

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Relations of Second Part

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Anterior Relations of 1st part Rt lobe of liver Transverse colon

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Right lobe of liver Beginning of transverse colon Coils of jejunum Anterior relations of 2nd part

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Hilum of right kidney Posterior relations of 2nd part Right psoas major m.

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Posterior relations of 2nd part Right kidney Right psoas major muscle

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Right & Left relations of 2nd part Right colic flexure Ascending colon Head of pancreas

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Superior pancreatico- duodenal vessels Inferior pancreatico duodenal vessels

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Hepato-pancreatic ampulla of vater Postero-medial aspect of the middle of second part

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1st 2nd 3rd 4th Major duodenal papilla Minor duodenal papilla

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Relations of 3rd part

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Superior mesenteric artery in root of mesentery of small intestine Anterior Relations of 3rd part 3rd part of duodenum

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Right psoas Right ureter Inf. Vena cava Right gonadal Aorta Inferior mesenteric art. Posterior (deep) & above (superior) relations of 3rd part Head of pancreas

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Relations of 4th part

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Dr. Sherif Fahmy

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Transverse colon

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Left psoas major m. Left sympathetic chain Uncinate process Abdominal aorta Posterior, Right and Left Relations Hilum of left kidney

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Blood Supply of Duodenum

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Hepatic artery Superior mesenteric artery Gastro-duodenal a. Superior pancreatico- duodenal Rt. Gastro-epiploic a Coeliac trunk Supra-duodenal (50%) Right gastric Inferior pancreatico- duodenal a.

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Portal vein Sup. Mesenteric vein Pancreatico- duodenal veins Rt. Gastro-epiploic vein Rt. Gastric vein

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Blood Supply of Duodenum

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Arterial Supply

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Hepatic artery Superior mesenteric artery Gastro-duodenal a. Superior pancreatico- duodenal Rt. Gastro-epiploic a Coeliac trunk Supra-duodenal (50%) Right gastric Inferior pancreatico- duodenal a.

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Venous Drainage

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Dr. Sherif Fahmy Right gastric vein Portal vein Right gastro- epiploic vein Superior & inferior pancreatico- duodenal veins Superior mesenteric vein

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Lymph Drainage

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Subpyloric nodes Suprapyloric nodes Coeliac nodes Hepatic nodes

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Nerve Supply From coeliac plexus: Parasympathetic: -Vagus. Sympathetic: -post-ganglionic branches of coeliac ganglia, preganglionic fibers from greater splanchnic nerve.

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Applied Anatomy ➢Duodenum is the commonest site of peptic ulcer. ➢Suspensory ligament of Treitz is a landmark to end of duodenum.

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Duodenal cap

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Jejunum & Ileum (Page 121)

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Duodenum Jejunum Ileum

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Duodeno-jejunal flexure Ileo-cecal junction

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Jejunum Ileum

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Vasculature Jejunum Ileum

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Mesentery of Small Intestine (Page 121)

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Course of the Root of the Mesentery

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Superior mesenteric artery in root of mesentery of small intestine Ileoceacal junction Dudeno- jejunal flexure Beginning & end of the root of the Mesentery

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Superior mesenteric a. Superior mesenteric vein 3rd part of duodenum Body of pancreas Course

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Contents of Mesentery 1- Jejunum and ileum. 2- Jejunal & ileal arteries. 3- Lymph nodes. 4- Extraperitoneal fat, lymphatics and autonomic nerves.

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Superior mesenteric artery in root of mesentery of small intestine Ileoceacal junction Dudeno- jujenal flexure Beginning & end of the root of the Mesentery

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Superior Mesenteric Artery (Page 156)

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Abdominal aorta Coeliac artery Superior mesenteric artery Inferior mesenteric artery

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Superior mesenteric artery in root of mesentery of small intestine Ileoceacal junction Splenic vein Course of Superior Mesenteric Artery Left renal vein Body of pancreas (cut)

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Course & Relations

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Abdominal aorta Inferior vena cava Right ureter and psoas major m. Ileo-caecal junction Head of pancreas Superior mesenteric artry

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Branches of Superior Mesentric Artery

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1- Inferior pancreatico- duodenal. 2- Jejunal & ileal 3- Middle colic. 4- Right colic. 5- Ileocolic.

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Inferior pancreatico- duodenal a Right colic art. Ilio-colic art.

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Jejunal arteries Ileal arteries

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Superior mesenteric a. Inferior pancreatico- duodenal a.

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Jejunal arteries Ileal branches Middle colic a. Right colic a. Ilio-colic a.

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Large Intestine (Page 126)

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Orientation For Relations

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Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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Dr. Sherif Fahmy

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General Orientation of Posterior Abdominal Wall

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Psoas major m Iliacus m Iliac crest Quadratus lumorum m Transversus abdominis Lateral arcuate ligament Medial arcuate ligament Diaphragm Dr. Sherif Fahmy

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Lumbo- sacral trunk Obturator n Genito-femoral nerve Femoral nerve Lat. Cut. Nerve of Thigh Ileo-hypogastric nerve Ileoinguinal n Subcostal vs & n Dr. Sherif Fahmy

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Aorta IVC Common iliac artery External iliac artery Dr. Sherif Fahmy

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Site & parts

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Appendix Ceacum Ascending colon Rt. Colic flexure Transverse colon Lt colic flexure Descending colon Pelvic colon

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Sigmoid colon Rectum Anal canal

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Characters

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Sacculation Taenia coli Appendices epiploicae

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Tinea coli Sacculations Appendicis epiploice

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Ceacum (Page 128)

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Site & Surface Anatomy

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Rt. Mid- clavicular plane Transtubercular plane Inguinal ligament

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Relations

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Anterior Relations Greater omentum Coils of small intestine

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Psoas major m. Femoral nerve Lateral cut. N. of thigh over iliacus m. Gonadal vessels

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Psoas major m Iliacus m Iliac crest Quadratus lumorum m Transversus abdominis Lateral arcuate ligament Medial arcuate ligament Diaphragm

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Lumbo- sacral trunk Obturator n Genito-femoral nerve Femoral nerve Psoas major m. Lat. Cut. Nerve of Thigh Iliacus m. Iliac crest Ileo- hypogastric nerve Ileoinguinal n Subcostal vs & n

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Peritoneal Relations (Page 93)

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Orifices

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Blood Supply

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Lymph Drainage

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Vermiform Appendix (Page 119)

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Appendix (2 – 20 cm) Caecum

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Caecu m Appendix Mesoappendi x tenia coli

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Site

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Shape, length and orifice

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Opening of appendix Ileocecal orifice (valve)

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Positions of Appendix

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Retrocecal 75% Pelvic 20% Subcecal Preileal Postileal

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Transverse section of vermiform appendix

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Mesoappendix & Blood Supply

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Appendicular artery Mesoappendix

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Superior mesenteric artery Ileocolic artery Blood supply of appendix

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Lymph Drainage

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Nerve supply: A-Parasympathetic: Vagus nerve. B-Sympathetic: From Caeliac plexus through superior mesenteric plexus.

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Surface Anatomy

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McBurney’s point Surface anatomy of base of appendix

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Ascending & Descending Colons (Page 134)

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Relations of Ascending & Descending Colons

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Blood Supply

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Lymph Drainage

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Transverse Colon

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Relations of Transverse Colon

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A- Superficial Relations

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B- Deep Relations

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Peritoneal Covering

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Transverse Mesocolon

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Colic Flexures

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Blood Supply of Colic Flexures

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Sigmoid (pelvic) Colon

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Relations of Sigmoid Colon

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Peritoneal Coverings

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Blood Supply & Lymph Drainage

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Arterial Supply of Colon (Page 147)

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Lymph Drainage of Colon

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Nerve Supply of Colon -Parasympathetic supply. -Sympathetic.

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Inferior Mesenteric Artery (Page 161)

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Abdominal aorta Common iliac artery Coeliac artery Superior mesenteric artery Inferior mesenteric artery

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Inferior mesenteric a. Superior rectal a.

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Branches of inferior mesenteric artery: 1- Superior left colic. 2- Inferior left colic (sigmoidal). 3- Superior rectal artery.