the abdomen stuart m bunt functional anatomy 212
TRANSCRIPT
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The Abdomen
Stuart M Bunt
Functional Anatomy 212
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Overview
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Embryology Revision
Foregut, Midgut and Hindgut suspended by the dorsal mesentary, initially straight
Ventral mesentary connects stomach and ant. abd. wall, rest of gut free anteriorly
Mesentary supplies blood and nerves to gut between layers of peritoneum
Complex adult layout due to 270o rotation
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Blood Supply to Abdominal Organs Foregut
Celiac trunk Midgut
Superior mesenteric artery Hindgut
Inferior mesenteric artery Rectum
Internal iliac artery (pudendal and rectal arteries)
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Stomach Variable size and shape,
distensible J shaped related to body
form Lesser and greater
curvature gastroesophageal
junction fundus,cardiac part,
body, pyloric part pyloric antrum and
sphincter rugae and gastric pits
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Blood Supply of Stomach
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Superior Mesenteric Artery Territory
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Inferior mesenteric artery territory
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Venous system
Portal Vein Splenic vein
inferior mesenteric vein
Superior mesenteric vein
Gastric veins Hepatic Veins
Inf. Vena CavaInf. Vena Cava
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Anastomoses
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Stomach rotates and distends
Front
Back
OmentumOmentum
Dorsal Dorsal MesentaryMesentary
VentralVentralMesentaryMesentary
Splenic Splenic tissuetissue
Epiploic Foramen
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Omentum
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Under the OMENTUM
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The Peritoneal cavity is divided in two
Rotation of stomach forms the greater omentum(allows stomach distension and infection control)
Omental bursa or Lesser sac is inside omentum (a potential space)
Lesser omentum runs from stomach to liver(note free lower border above epiploic foramen
contains portal vein, hepatic artery and bile duct
Falciform ligament runs from liver to ant abd. wall
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Mesenteries are important:-
Paracolic gutters channel fuid Stop herniation due to bipedal posture Supply blood/nerves Sensitive to stretch Contain infection Useful in surgery
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On return some gut fuses with posterior wall
Rectum
Desc. ColonAsc. Colon
Duo.
12
3
41.lienorenal lig.2.trans. mesocolon3.mesentary proper4.mes. of sig. colon
Diaphragm
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Retro-peritoneal
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Oesophagus 10 inches from pharynx to stomach narrow
at cricoid cartilage where left bronchus crosses oesophageal hiatus in diaphragm
mucous membrane folded (normally collapsed) stratified squamous epithelium striated above smooth below trachea on right, lower aorta on left medial to L. lung, behind left atrium
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Duodenum
first 12 inches of gut four parts form C shape
duodenal cap radiologically identified, ulcers form here mobile
descending part pancreatic and bile ducts
horizontal part crosses psoas, IVC and aorta crossed by mesentery, sup mesen. art.
ascending part
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Jejunum 2/5ths of small
intestine gradual transition to
ileum many small villi increasing numbers of
lymph nodules no submucosal glands lacteals in each villus columnar epithelium
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Ileum
distal 3/5ths of intestine narrower, thinner, less
vascular, slower, more fat and arterial arcades
in mesentery than jejunum. Peyer’s patches of lymphoid
tissue
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Colon ascending colon
retroperitoneal right colic or hepatic
flexure transverse colon
(mesocolon) droops towards pelvis? left colic or splenic
flexure descending colon
retroperitoneal pelvic or sigmoid colon S
shaped
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Colonoscopy
Barium enema outlines structures on X-rays
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Appendix
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The Liver Largest Gland (one
of largest organs) Right upper
abdomen under diaphragm
Grows as outgrowth of gut plus mesoderm
Diaphragmatic surface
Visceral surface down and left related to
stomach, duodenum, r. kidney, r. colonic flexure
bears gall bladder
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Biliary System R and L Hepatic ducts Common hepatic duct Joined by cystic duct (to
gall bladder) Forms bile duct
(common bile duct) Gall Bladder
body and fundus, salts and water absorbed
store for bile, released in response to cholecystokinin
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Pancreas
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Pancreas
Head in concavity of duodenum body across vertebrae tail reaches the spleen pancreatic duct (+ accessory?) ampulla duodenal papilla
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Spleen
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The Spleen Lies in left hypochondriac region between
gastric fundus and diaphragm at level of 9th-10th rib (not normally palpable)
Soft, friable, highly vascular, dark purple Diaphragmatic surface
convex and smooth facing diaphragm Visceral surface
gastric, renal, pancreatic and colic impressions
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The Spleen (2)
Hilum of spleen long fissure through which vessels and nerves pass
Suspended from stomach by gastrolienal ligament (contains short gastric and left gastro-epiploic branches of spenic artery)
Suspended from posterior abdominal wall by lienorenal ligament
Covered by adherent peritoneum
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Relationship to the Spleen
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Kidneys
In fat capsule
Suprarenal glands superiorly
Direct Arterial and venous supply
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Kidney Internal Structure Renal pyramids
between renal columns
Renal Cortex Renal papillae
drain into minor calix
Major calix join to form renal pelvis
Ureter as outlet
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Kidneys External View
Artery - Vein - Ureter
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Relationships of the Kidneys