radiological anatomy of abdomen

1. SECTION OF RADIOLOGY (I.M.)
DEPARTMENT OF SHALYATANTRA, IMS-BHU
Presented by – Guided by –
Dr . Madan jakhar Prof S.S. MISHRA

2. INDEX
A)Landmarks of abdomen
B).Radiological modalities use for abdomen
C)Surface and radiological anatomy of different organs of
abdomen
1) Liver
2) Gall bladder
3) Pancreas
4) Spleen
5) Stomach
6) Small Intestine
7) Large Intestine
8) Kidney & Ureter –Right & Left
9) Urinary Bladder

3. Surface Anatomy-Quadrants & Regions
 Upper transverse
plane.
 Lower transverse
plane.
 Sagittal planes at
right angles to
transverse planes
divide the abdomen
into four quadrants
and nine regions .

4. Transverse planes
Trans pyloric plane-lies
A lower border of L1
Trans tubercular plane-lies
Upper border of L5
Sagittal planes-
Median vertical planes-
Symphysis pubis to supra –
Sternal notch
Rt & LtVerticalplanes -

5. Abdomen Radiography-Quadrants

6. Imaging Modalities for the Abdomen and Pelvis.
Commonly utilized modalities :
• Ultrasound
• CT (computed tomography)
• Abdominal plain film
• Fluoroscopy
• Hysterosalpingography
Other modalities:
•MRI [Magnetic resonance imaging]
•Nuclear medicine
•Gallium scan
•Positron EmissionTomography (PET).

7. X ray Abdomen
 The most common plain radiograph of the
abdomen is an anteroposterior (AP) view with the
patient in the supine position.
 The AP view of the abdomen is also called a KUB
film because it includes the kidneys, ureters, and
bladder.
 When acute abdominal disease is suspected
clinically, an erect film of the abdomen and a
posteroanterior (PA) view of the abdomen are also
required.

8. Abdomen - plain film Anatomy
A Normal plain film of the
abdomen.The lower margins of
the posterior portion of the
liver, the hepatic angle (H), and
the lower part of the spleen (S)
are delineated by a fat shadow.
Both kidneys (K) and the psoas
muscle shadows (arrowheads)
are outlined by a fat shadow.
The properitoneal fat stripe is
also shown bilaterally (arrows).

11. STOMACH
WITHOUT CONTRAST
COLON
UPPER GI ORAL BARIUM
CONTRAST.
BARIUM

13. Abdomen Anatomy-Liver
Liver- present in RUQ.
Two major lobes two
minor lobes.
Falciform ligament
separates larger Rt lobes
from Lt lobe ,small
quadrate lobe lies inferior
to Rt lobe and posterior
to quadrate lobe lies
caudate lobe

14. Liver-Introduction
 Occupies the right hypochondrium, epigastrium & left
hypochondrium.
 Most part of the liver is covered by ribs & costal cartilages.
 It is covered by network of connective tissue (Glisson’s Capsule)

15. 1cm
1cm1cm
4-5cm
8th rib
Xiphisternal j
5R
6-12cm
4-8cm

18. IMAGE OF PORTA HEPATIS SHOWING CBD & MAIN
PORTALVEIN

19. BiliaryApparatus :
It collects bile from the liver ,stores in the
gallbladder & transmits to 2nd part of duodenum.
 Gall bladder.
 Cystic duct.
 Right and left hepatic ducts which unite to form
Common Hepatic Duct.
 Common Bile duct formed by the union of cystic
duct and common hepatic duct.

20. Parts of Gall Bladder
 Fundus
 Body
 Neck
 Infundibulum
 Cystic duct

21. Gall Bladder
 Gall bladder – a pear shaped sac and reservoir of bile and is
responsible for concentration of bile. It can hold upto 30-50
ml.
 9-10 cm long , 4 cm in diameter.
 Wall thickness < 3mm.
 Hangs from inferior surface of liver – fundus usually anterior
and inferior to body and neck.
 Cystic duct arises from the neck of the gallbladder.
 Neck and cystic duct has spiral appearance to the mucosal
folds (spiral valve of heister); on ultrasound it is highly
echogenic and may be mistaken for gallstones.

22. Radiological anatomy

23. Gb stones-Cholesterol and
pigment stones are
radiopaque and visible on
radiographs .
Porcelain Gall Bladder

24. Gross Anatomy of the Stomach
cardiac end - at the level ofT11
pylorus end – at the level of L2
Lesser curvature -
1. Greater curvature
2. Cardia - end under the heart
3. Fundus - bulge above the esophageal opening
4. Body - largest region
5. Pylorus - J curve, inferior end, terminates in
6. Pyloric sphincter and superior end terminates in
7. Cardiac spincter.
8. Rugae – highly extendable interior folds Figs 25-10/11

25. Abdomen Anatomy-Pancreas
PPancreas is transversely placed between L1
and L2. it has three parts head,body and tail .
It is partly exocrine and partly endocrine .
Endocrine part secretes insulin and glucagon .
Exocrine part secretes pancreatic juice .
The pancreatic duct opens in to second part
of duodenum .

28. Pancreas and its proportions + neighboring anatomical
structures in classic transverse epigastrial plain.

29. Spleen :
 Spleen is the largest organ of lymphatic system
in human body.
 Location: Lies along the axis of 10th rib.
 Size: normally varies from 7 to 12 cm in
length,7.5 cm broad and 2.5 cm thick.
 In usg - . Homogenous, moderately echogenic
( pancreas > liver > spleen )
•Visualized best obliquely in the 9th or 10th inter
costal spaces

30. Normal spleen.

31. Kidneys, Ureters and Urinary
Bladder Tract (KUB)
 KIDNEY -Usual
location – between
upper border of 12th
thoracic vertebra and
lower border of 3rd
lumbar vertebra
 On either side of the
lower thoracic and
upper lumbar spine

32. Relationship of the Kidneys to Vertebra and Ribs
12×6×3

33. Intravenous Pyelogram shows Kidneys, Ureters
and Urinary Bladder

35. Long axis of the
kidneys is directed
downward and
outward, parallel to
the lateral border of
the psoas muscles

36. Ultrasound of Right Kidney

37. Ureters
 25-30 cm in length and 2-8 mm diameter
 Course downwards from the most dependent
portion of the pelves to the midsacral region
 Then turn posterolaterally and course in an
arc downwards
 Then inward and anteriorly to enter the
trigone of the bladder on either side of the
midline

38. Urinary Bladder
 Neck of bladder - lies 3-4 cm behind lower part of
symphysis pubis and rests on the prostate in the
male
 It has the urethral orifice
 In females the peritoneum is reflected from the
superior surface of the bladder to the anterior
wall of the uterus at the junction between the
body and cervix
 The enclosed space is the vesicouterine pouch

39. Urinary Bladder
 Transverse image
through a normal
bladder using
ultrasound shows
normal anechoic
structure.

40. X ray showing urinary bladder stones

41. Regions of Small Intestine
SI is longest part of dig. tube
 Duodenum (short, 12 inches)
 fixed shape & position
 Mixing bowl for chyme
 Jejunum (2.5 m long)
 Most of digestion
 Ileum (longest at 3.5 m)
 Most of absorption, ends in
 Ileocecal valve – slit valve into large intestine (colon)

42. Cecum – pocket at proximal end with
Appendix
Colon
Ascending colon - on right, between
cecum and right colic flexure
Transverse colon - horizontal portion
Descending colon - left side, between
left colic flexure and
Sigmoid colon - S bend near terminal
end
Regions of Large Intestine
Fig 25-17
Rectum – terminal end is anal canal - ending at the anus - which has
internal involuntary sphincter and external voluntary sphincter

44. Summary of this ppt
-
 Liver - < 14.5 cm
12- 15 mild
 Spleen - < 12 cm >15 modrate
>18 gross spleenomegaly
 Kidney - 8 – 12 cm
30 mm head
 Pancrease - 20 mm body
25 mm neck

45.  wall thikness
GALL BLADDER
URINARY BLADDER 3 MM
SMALL BOWEL
Luminal diameter
SMALL BOWEL 3 CM
LARGE BOWEL 6 CM
CACEUM 9 CM
-

46.  DIAMETERS OFTUBULAR STRUCTURES: -
 PORTALVEIN - < 12 MM
 HEPATIC VEIN - < 9 MM
 < 6 MM - ADULT
CBD - < 8 MM - OLD
< 10 MM – POST
CHOLECYSTECTOMY
• IVC - <25 MM
• PANCREATIC DUCT - < 2 MM

48. To be continued….

50. The end … ..
.