anatomy of abdomen

1. ABDOMEN
BMS _DXGC 6180
Assoc. Prof. Dr. ROSIE PAMELA DAVID
Dept. Of Anatomy
Faculty of Medicine, UM

2. Lecture Contents:
• Ant. abdominal wall muscles & and
related surgical incisions
• Diaphragm and Post. abdominal
wall
• Inguinal region; clinical importance
• Abdominal viscera & accessory
organs
• Neurovascular supply, lymphatic
drainage and portal-systemic
anastomoses
• Clinical and radiological aspects

3. BONY STRUCTURES

4. ANTERIOR ABDOMINAL WALL
4
• Skin
• Superficial fascia
• Deep fascia
•Muscles
• Extraperitoneal
fascia
• Parietal peritoneum

5. Fx?
Lower
free
margin of
EO
MUSCLES

6. RECTUS SHEATH
6
Contents?

7. Tranversalis fascia
Extraperitoneal
tissue & peritoeum

8. Arteries of the
Anterior
Abdominal
wall

9. Veins
draining
the
Anterior
Abdominal
Wall

10. Dermatomes & nerves of
abdominal wall
10

11. neurovascular plane?
11

12. Lymphatics
12
Aortic nodes
Common iliac
nodes
superficial
deep

13. SURFACE ANATOMY
13

14. ABDOMINAL
SURGICAL
INCISIONS
In the direction of lines of
cleavage (Langer’s lines)
:bundles of collagen fibers in
dermis run in parallel rows.
14

15. Anterior
Abdominal
Wall:
Internal
View

16. 16
• Oblique passage through
the lower part of ant. abd.
wall. Lies parallel to inguinal
ligament.
• What does it transmit?
•Clinical importance?
*
*
*
*
INGUINAL
REGION/CANAL

17. Inguinal canal:
-2 openings, 4 walls
-contents?
Spermatic cord:
-coverings?
-contents ?

18. In females:

19. Inguinal canal in the male. A small
inguinal hernia (arrow) is present.
SIR
ilioinguinal nerve (cut).
female
male
ilioinguinal nerve (cut).
Round lig. of uterus

20. Posterior
Abdominal
Wall:
Internal
View
5 lumbar vert & IV
disc
Diaphragm?

21. QUADRANTS & REGIONS
21
Why know them?

22. PERITONEUM
What are they?

23. Peritoneal Cavity
Greater Sac
Lesser Sac
/omental bursa*
 Peritoneal ligaments
 Omenta
 Mesenteries
Permits blood, lymph vessels & nerves to reach

24. ABDOMINAL VISCERA
24
General arrangement of abdominal
viscera
Greater omentum ?

25. •2 openings, 2
curvatures & 2
surfaces
•Parts:
•Lesser omentum &
Greater omentum
•=gaster
STOMACH

26. Relations ?
 Ant: ant. Abd. Wall, left
pleura & lung, diaphragm,
left lobe of liver
 Post: lesser sac,
diaphragm, spleen and
splenic art., pancreas,
transverse mesocolon and
transverse colon

27. Blood supply
R & L gastric arteries - <r curvature
R & L gastroepiploic arteries - >r
curvature
Short gastric arteries - fundus
Veins drain into the portal circulation
 sympathetic fibers from celiac plexus
 parasympathetic fibers from left (anterior)
& right (posterior) vagal trunks
Nerve supply

28. Lymphatic
drainage
28

29. SMALL INTESTINE
- Duodenum
- Jejunum
- Ileum

30. DUODENUM
Arterial supply?
Venous drainage?

31. Main pancreatic duct or duct
of Wirsung & common bile
duct open into _______________
Accessory pancreatic duct or
duct of Santorini opens into
_____________

32. Jejunum and Ileum
__________ (LUQ)
_____________(RLQ)
The mesentery
(cut) attached to
PAW
Greater omentum lifted to display
jejunum & ileum “framed” by colon
Function ?
Intraperitoneal or Retroperitoneal?
Greater omentum

33. Jejunum
Feathery appearance
due to mucosal folds
Fat-free windows near wall (between vasa recti)
Ileum
Filled with barium
Peyer’s patches
Fat encroaches onto wall
Meckel’s
diverticulum
Ileum
Meckel’s (ileal)
diverticulum
Appendix
Intussusception
More fat in mesentery
arterial arcades that are long & straight numerous short vessels,
3-4 arterial arcades
Isolated lymph follicles

34. LARGE INTESTINE

35. Cecum & Appendix
Appendix Surface anatomy-?
Commonest positions-
retrocaecal, pelvic
Arterial supply?

36. Differences between small and large
intestine
Small intestine has
________________________________________
Large intestine has
_________________________________________

37. Arterial supply and venous drainage
of digestive tract.
L1

38. Blood supply of the Gut
Foregut- supplied by _______
Midgut- supplied by ________
Hindgut- supplied by _______

39. LIVER
Anterior view
Inferior / visceral view

40. The portal triad passes between the layers of the HD
ligament to enter the liver at the porta hepatis. The
common hepatic artery passes between the layers of
the HG ligament.

41. PORTAL VEIN
Portal V
(formed behind neck of
pancreas)
superior mesenteric V
• Drains blood from abd. part of GIT (also
spleen, pancreas & gall bladder)
splenic V

42. Portal vein-valveless
PORTAL
SYSTEMIC
ANASTOMOSES
42

43. caput medusae accentuated by
a large amount of ascites
(arrows) -superficial epigastric
vein, which drains into the
external iliac vein
Henseler K P et al. Radiographics 2001;21:691-704

44. GALL BLADDER
Surface anatomy of fundus
of GB?
Fx?

45. PANCREAS
45
• Composite, lobulated organ
• crosses transpyloric plane.
• Arterial supply?
• Pancreatic injury?
HA
Gastroduodenal A
Sup pancreaticoduodenal A
Inf pancreaticoduodenal A
SMA
splenic A
& br to
pancreas
(body &
tail)
Pancreatic duct

46. SPLEEN
• Notches along the
anterior border
•Supplied by large
splenic artery
(largest br. of celiac
artery)

47. Anterior end
Posterior
end Superior border
Inferior
border
Gastrosplenic
(gastrolienal) ligament
(containing
___________)
Splenorenal (lienorenal)
ligament (containing
_______________)
Spleen
– Visceral surface
Spleen is _______________.
Peritoneum reflects away as
‘ligaments’ at hilum.

48. Spleen – Diaphragmatic surface
Through the diaphragm, it is related to ribs ___, _____ & ___(long axis of spleen is oblique and parallel to
rib __)

49. Posterior abdominal wall showing great
vessels, kidneys, & suprarenal glands.
Retroperitoneal
organs- (1°) Kidney,
ureter, u’ bladder;
(2°) duodenum, AC,
DC, Rectum,
pancreas

50. KIDNEYS
Structures entering the hilum –surgery of renal vasculature

51. Posterior relations-

52. Surface anatomy of hilum
Renal transplantation?
52
KIDNEY

53. -constrictions
-ureterolithiasis
53
URETER
Referred pain

54. SUPRARENAL GLANDS
R L

55. ABDOMINAL
AORTA
aortic opening - T12, divides into 2
common iliac arteries at L4
1) 3 anterior visceral branches
2) 3 lateral visceral branches
3) 5 lateral abd wall branches
4) 3 terminal branches

56. INFERIOR
VENA CAVA
Drains blood from below diaphragm
into R atrium of heart. Formed by union
of common iliac veins behind R
common iliac artery (L5).
Tributaries-
1) 2 anterior visceral
2) 3 lateral visceral-
( L side drain into L renal vein for
suprarenal & gonadal)
3) 5 lateral abdominal veins
4) 3 tributaries of origin
1
2
2
2
3
3
4
4

57. NERVES OF POSTERIOR
ABDOMINAL WALL
L4, L5
Sacral plexsus (L4-S4)

58. Clinical & Radiological
aspects

59. PROTUBERANCE OF ABDOMEN
6Fs:
food,
fluid,
fat,
feces,
flatus &
Fetus
Also pathology
/organomegaly

60. Referred pain?

61. ANTERIOR
ABDOMINAL
HERNIA

62. Which type extends down into the
scrotum?
direct inguinal hernia
indirect inguinal hernia
*
Medial to

63. Bilateral hydrocele
* Metastasis of cancers of scrotum differs from testis

64. Torsion of spermatic cord
may result in irreversible
damage to the testicle
cryptorchidism : failure of one or
both of the testes to descend into the
scrotum

65. GALL BLADDER
Healthy gall bladder cannot be palpated
Surface marking?
 radiograph reveals multiple
calculi in the right upper
quadrant, diagnostic of
gallstones.

66. Palpation of an enlarged spleen
is demonstrated.
SPLEEN

67. AP radiograph of the
abdomen
12th
rib
Iliac crest
R
kidney

68. AP radiograph of the stomach &
SI after ingestion of barium
meal.
Barium
in body
of
stomach
*
*
*

69. AP radiograph of the duodenum after ingestion of barium meal
Duodenal cap

70. AP radiograph of the LI after
a barium enema

71. AP radiograph kidneys 15 minutes after IV injection of an iodine-containing
compound.

72. Courtesy of Intermountain Medical Imaging, Boise, Idaho.
normal abdomen air trapped in the bowels

73. Q?

74. THE END