abdomen ii 11-19-2015 student

7/23/2019 Abdomen II 11-19-2015 Student

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ABDOMEN II

11-19-2015



PERITONEAL CAVITY • Serous membrane lining

peritoneal cavity –

peritoneum

• Priet! and "i#$er! layers

• Me#enterie# – double layersof serous membrane thatsuspends organs

•

Omentum – mesentery thatattaches to stomach – Specialized mesentaries

• Intrperitone! – organsalmost completely surroundedby peritoneum; suspended by

mesentery • Retroperitone! – organs only

partially covered byperitoneum; no mesentery – Duodenum, pancreas

– Pressed up against posterior abdominal

wall

– Aren't suspended by a mesentery



PERITONEAL CAVITY • mbryonic gut tube suspended from posterior abdominal wall by

me#enter%

• At this point entire gut tube is an intrperitone! structure

• At end of development some organs remain intraperitoneal!retain mesentery", other organs get pushed up against posteriorabdominal wall

– #ecome retroperitone! – no mesentery; only covered on

one surface by peritoneum



$nferior border

%&th costal cartil

$liac tubercles() vertebra

(*+ $ disc

RE&ION' O(ABDOMINAL )ALL



A*TONOMIC' TO ABDOMINAL VI'CERA

• Parasympathetics

– -ranial• Preganglionic .bers in "+u#

nerve

• Postganglionic neuron inganglion within wall of organ

• A!! t,or$i$ or+n#

.ore+ut n/ mi/+ut#tru$ture#

– Sacral

• Preganglionic .bers innterior rmi '2- pe!"i$#p!n$,ni$ ner"e#

• Postganglionic neuron inganglion within wall of organ

• 3in/+ut #tru$ture# n/pe!"i$ or+n#



A*TONOMIC' TO ABDOMINAL VI'CERA

• Sympathetics

– Preganglionic .bers in anterior rami

of /)0(* – Pre+n+!ioni$ 4er# /o not

#%np#e in #%mpt,eti$ trun67p## t,ru it

• (orm

– T,or$i$ #p!n$,ni$ ner"e#

– Lumr #p!n$,ni$ ner"e#

• Splanchnic nerves go topre"erter! +n+!i

– Ce!i$ +n+!ion 8po#t+n+!ioni$ 4er# to

.ore+ut #tru$ture#6i/ne%# #p!een

– 'uperior me#enteri$+n+!ion 8 mi/+ut#tru$ture#

– In.erior me#enteri$

+n+!ion 8 ,in/+ut#tru$ture#



E'OP3A&*'• -ourses thru esophageal hiatus of diaphragm to empty into stomach

• Primary blood supply e#op,+e! rterie# !descending thoracic

aorta"; e#op,+e! "ein# drain into azygos system• $nnervated by e#op,+e! p!eu#1 !coming from the vegas nerves"

– Sympathetics from T:-; ganglia of sympathetic trun2;parasympathetics from "+! trun6#



'TOMAC3• 3ostly left upper 4uadrant

• $ntraperitoneal

• -hief function is enzymatic digestion; converting food into chyme

• * prominent double layers of peritoneum1

– Le##er omentum – lesser curvature to liver

– &reter omentum – greater curvature to transverse colon



'TOMAC3• 5 parts1

– Cr/i

– (un/u#

– Bo/%

– P%!oru#

• P%!ori$ ntrum-p##+e<%

• P%!ori$ $n!

– P%!ori$ #p,in$ter

– $nternal features – ru+e orgastric folds

– Allows for the stomach to e6pand

• -urvatures1 – Le##er $ur"ture

– &reter $ur"ture

7ugae !gastric folds"



'TOMAC3 8 ARTERIAL '*PPLY • All + branches celiac trun2

– Le.t +#tri$ rter%=• 'upp!% t,e !e##er $ur"ture o. t,e

#tom$,

– Splenic artery• ',ort +#tri$ rterie#=

– *pper prt o. t,e +reter$ur"ture o. t,e #tom$,

• Le.t +#tro-oment! rter%=

– Lo<er prt o. t,e +reter$ur"ture o. t,e #tom$,

• Pancreatic arteries

– -ommon hepatic artery

8supply stomach



'TOMAC3 8 ARTERIAL '*PPLY • -ommon hepatic artery

– 9astroduodenal artery

• Ri+,t +#tro-oment! rter%=

– &reter $ur"ture o. #tom$,>n#tomo#e <it, ri+,t +#tro-oment!

• Superior pancreaticoduodenal artery

– :epatic artery proper• Ri+,t +#tri$ rter%=

• (eft and right hepatic arteries• -ystic artery o right hepatic artery

8supply stomach



'TOMAC3

• Arteri! #upp!%

– Le##er $ur"ture

• Le.t +#tri$ rter%

• Ri+,t +#tri$ rter%

– &reter $ur"ture

• Ri+,t +#tro-oment!rter%

• Le.t +#tro-oment!rter%

• ',ort +#tri$ rterie#



3EPATIC PORTAL 'Y'TEM



'TOMAC3• enous drainage

– Similarly named veins into hepatic portal system1 !e.t n/ ri+,t

+#tri$ "ein# ri+,t n/ !e.t +#tro-oment! "ein# #,ort+#tri$ "ein#



'TOMAC3• $nnervation

– Sympathetics1 t,or$i$ #p!n$,ni$ ner"e# ?? $e!i$+n+!ion

– Parasympathetics1 "+! trun6# !both anterior and posterior"



D*ODEN*M• 7ight and left upper 4uadrants

• #rea2down of chyme in small intestine

• 5 parts1 #uperior tt$,e# to p%!ori$ prt o. #tom$,/e#$en/in+ in.erior ,ori@ont! #$en/in+

• 3ostly retroperitoneal



D*ODEN*M

• Arterial supply – -eliac trun2

• 9astroduodenalartery

– 'upr/u/oen!

rter%= – 'uperior

pn$reti$o/uo/en! rter%=

–

Superior mesenteric• In.erior

pn$reti$o/uo/en! rter%=

8supply duodenum



D*ODEN*M

• Similarly named veins intohepatic portal system

• $nnervation

– Sympathetics1 t,or$i$#p!n$,ni$ ner"e# ??$e!i$ n/ #uperiorme#enteri$ +n+!i

– Parasympathetics1 "+!

trun6#



E*N*M AND ILE*M

• 3ost <e<unum in upper left; most ileum in lower right

• Suspended by a mesentery; intraperitoneal• =utrient absorption



E*N*M AND ILE*M

• Arterial supply1

– Superior mesenteric artery

• eun! rterie#

• I!e! rterie#

• Similarly named veins drain intosuperior mesenteric vein ofhepatic portal system

• $nnervation

– Sympathetics1 t,or$i$#p!n$,ni$ ner"e# ??#uperior me#enteri$+n+!ion #%np#e in

– Parasympathetics1 "+!trun6#



LAR&E INTE'TINE

•

-ourses thru all 5 4uadrants• Absorbs water, ions, vitamins

• -ompacts chyme into feces

• -onsists of 1

–

Ce$um – Vermi.orm ppen/i

– Ascending colon

– Trn#"er#e $o!on

– Descending colon

–

'i+moi/ $o!on – 7ectum

– >pper anal canal

#old ? intraperitoneal parts; others retroperitoneal

3idgut

:indgut



LAR&E INTE'TINE• I!eo$e$! un$tion

– I!ium /ump# into t,e#$en/in+ prt o. $o!on

• * uni4ue e6ternal features

– Tenie $o!i – + bands oflongitudinal smoothmuscle

• /issues running lengthwiseon surface of large intestine

• Peristalsis movementthrough intestine

– 3u#tr – sacculations ofthe wall

• Sac0li2e structures

• isible from 60rays

• Ri+,t $o!i$ ,epti$eure – Ri+,t o"e i# !i"er

• Le.t $o!i$ #p!eni$ eure – 'p!een re#t# % it



LAR&E INTE'TINE

• Superior mesenteric artery

– Mi//!e $o!i$ rter%=

– Ri+,t $o!i$ rter%=

– I!eo$o!i$ rter%=

• Appen/i$u!r rter%=

• $nferior mesenteric artery

– Le.t $o!i$ rter%=

– 'i+moi/ rterie#=

– 'uperior re$t! rter%=

• All <oin to form @marginalartery

8 supply large intestine



LAR&E INTE'TINE

• Similarly named veins draininto hepatic portal system

• Sympathetics1

–

3idgut part 8 t,or$i$#p!n$,ni$ ner"e# ??#uperior me#enteri$+n+!i

– :indgut part 8 !umr#p!n$,ni$ ner"e# ??

in.erior me#enteri$+n+!ion

• Parasympathetics1

– 3idgut part 00 "+!trun6#

–

:indgut part 00 pe!"i$#p!n$,ni$ ner"e#



LIVER

• (ocated mostly upper right4uadrant

• 3ostly intraperitoneal

• 7eceives all nutrients !e6ceptlipids" from digestive tract directlyfrom portal veins

• Stores and modi.es vitamins

• Degrades to6ins and drugs

• 3etabolism

•

#ile production



LIVER

• 5 lobes

– Diaphragmatic surface

• Ri+,t and !e.t !oe#

– Separated by .!$i.orm!i+ment 2 !%er# o.#erou# memrne

» -ontains !i+ment tere#roun/ !i+ment o.!i"er

• Reminnt o. t,eumi!i$! "ein

– Coronr% !i+ment# are

serous membrane that reBecto liver onto underside ofdiaphragm

– isceral surface• >nderside of the liver

• u/rte and $u/te !oe#

Anterior view

$nferior view



LIVER• Cuadrate and caudate

lobes separated from leftlobe by

– Li+mentum tere# o.!i"er

– Li+mentum"eno#um

• More #uperior$!o#er toin.erior "en $"

• 3i!um !porta hepatis"separates 4uadrate andcaudate lobes

– 3epti$ rterie#

– 3epti$ /u$t#

– 3epti$ port! "ein – Autonomi$#

• In.erior "en $" and+!! !//er separateright lobe from 4uadrate

and caudate lobes

(igamentum venosum

isceral surface



LIVER

• Arterial supply

– :epatic artery proper

• Ri+,t n/ !e.t,epti$ rterie#

– 3epti$ port! "ein• Crr%in+ nutrient# into

!i"er

• enous drainage ,epti$"ein# ?? in.erior "en$"

•

Sympathetics1 t,or$i$#p!n$,ni$ ner"e# ??$e!i$ +n+!ion

• Parasympathetics1 "+!trun6#



&ALL BLADDER• >pper right 4uadrant

•

isceral surface liver• 3ostly intraperitoneal

• Stores and concentrates bile

• C%#ti$ /u$t <oins $ommon

,epti$ /u$t to form$ommon i!e /u$t

• -ommon bile duct receives

min pn$reti$ /u$t –common area is

,eptopn$reti$ mpu!!

• pening into duodenum!descending part" is mor/uo/en! ppi!!

:epatopancreatic ampulla



&ALL BLADDER

• Arterial supply

– C%#ti$ rter% oright hepatic artery

• enous drainage

– C%#ti$ "ein into

hepatic portalsystem

• Sympathetics1t,or$i$ #p!n$,ni$

ner"e# ?? $e!i$+n+!ion

• Parasympathetics1"+! trun6#

-ystic artery



PANCREA'

• 7ight and left upper4uadrants

• 3ostly retroperitoneal

• Secretes digestiveenzymes !e6ocrine" andglucagon and insulin

!endocrine"



PANCREA'

• 3e/ – curvature duodenum!superior, descending, inferiorparts"

• Ne$6 – pyloric region stomach;

superior mesenteric arteryvein• Bo/% – anterior to splenic

artery and vein

• Ti! – anterior to left 2idney

• Min and $$e##or%pn$reti$ /u$t#

:ead

=ec2

#ody

/ail

3ain pancreatic ductAccessory pancreatic duct



PANCREA'

• Arterial supply – Pn$reti$ rterie# o

splenic artery

– 'uperiorpn$reti$o/uo/en!rter% ogastrodudodenal artery

– In.eriorpn$reti$o/uo/en!rter% superiormesenteric artery

Pancreatic arteries

Superior pancreaticoduodenal artery

$nferior pancreaticoduodenal artery



PANCREA'

• Similarly named veins draininto hepatic portal system

• Sympathetics1 t,or$i$#p!n$,ni$ ner"e# ??

$e!i$ n/ #uperiorme#enteri$ +n+!i




'PLEEN• (eft upper 4uadrant

•

$ntraperitoneal

• (argest lymphoid organ

• 7emoves old 7#-s



'PLEEN

• Arterial supply

– 'p!eni$ rter% oceliac trun2

• enous drainage

– 'p!eni$ "ein ??

,epti$ port! "ein

• Sympathetics1 t,or$i$#p!n$,ni$ ner"e# ??$e!i$ +n+!ion


abdomen ii 11-19-2015 student

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