Lesson+5_Abdomen.pptx
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Lesson 5 Abdomen Human Anatomy and Embryology Prof. Mar Ubero Dentistry Index CONTENT - Abdomen: - Abdominopelvic regions. - Muscles. -Peritoneum and peritoneal cavity. - Inguinal canal. 1. Abdomen: 4th intercostal space Pelvic inlet 1. Abdomen: abdominopelvic regions ABDOMINOPELVIC QUADR...
Lesson 5 Abdomen Human Anatomy and Embryology Prof. Mar Ubero Dentistry Index CONTENT - Abdomen: - Abdominopelvic regions. - Muscles. -Peritoneum and peritoneal cavity. - Inguinal canal. 1. Abdomen: 4th intercostal space Pelvic inlet 1. Abdomen: abdominopelvic regions ABDOMINOPELVIC QUADRANTS: Topographical divisions Used to abdominal describe organs the and location the of pain associated with abdominal problems. 1. Abdomen: abdominopelvic regions Median plane Right upper quadrant (RUQ) Left upper quadrant (LUQ) Right lower quadrant (RLQ) Left lower quadrant (LLQ) Transumbilical plane 1. Abdomen: abdominopelvic regions Martini FH, Tallitsch RB, Nath JL. Human Anatomy. 8th Edition. Pearson Education SA, 2018. 1. Abdomen: abdominopelvic regions ABDOMINOPELVIC REGIONS: Topographical divisions used to describe the location and orientation of internal organs more precisely. Nine-region pattern is based on two horizontal and two vertical planes. - The superior horizontal plane (the subcostal plane) is immediately inferior to the costal margins, which places it at the lower border of the costal cartilage of rib X. - The inferior horizontal plane (the intertubercular plane) connects the tubercles of the iliac crests. - The vertical planes (the midclavicular planes) pass from the midpoint of the clavicles inferiorly to a point midway between the anterior superior iliac spine and pubic symphysis. 1. Abdomen: abdominopelvic regions Midclavicular planes Right hypochondriu m Epigastric region Left hypochondriu m Right flank Umbilical region Left flank Right groin Pubic region Left groin Subcostal plane Intertubercul ar plane 1. Abdomen: abdominopelvic regions Martini FH, Tallitsch RB, Nath JL. Human Anatomy. 8th Edition. Pearson Education SA, 2018. 1. Abdomen: abdominopelvic regions Skin, superficial fascia (subcutaneous tissue), muscles and their associated deep fascias, extraperitoneal fascia, and parietal peritoneum. 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES 5 muscles in the anterolateral wall: - 3 flat muscles whose fibres begin posterolaterally: • External oblique. • Internal oblique. • Transversus abdominis. - 2 vertical muscles, near the midline, which are enclosed within a tendinous sheath by the aponeuroses of the flat muscles. • Rectus abdominis. • Pyramidalis. 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES • To keep viscera within the abdominal cavity and protect them from injury. • To assist in both quiet and forced expiration (internal oblique and transversus abdominis by pushing viscera upward). • To assist in any action that increases the intra-abdominal pressure: coughing, vomiting, parturition, micturition and defecation. 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES FLAT MUSCLES: EXTERNAL OBLIQUE MUSCLES - The most muscle. superficial - Inferomedial direction. - Large aponeuroses covers the anterior part of the abdominal wall to the linea alba. 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES FLAT MUSCLES: EXTERNAL OBLIQUE MUSCLES Associated ligaments: -Inguinal ligament. -Lacunar ligament. 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES - Smaller and thinner that the external oblique. - Superomedial direction. - Aponeuroses blends into the Linea alba. FLAT MUSCLES: INTERNAL OBLIQUE MUSCLES 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES FLAT MUSCLES: TRANSVERSUS ABDOMINIS MUSCLES - Deep to the internal oblique muscle. - Horizontal orientation of its muscular fibres. - It ends in an anterior aponeuroses, which blends with the Linea alba. 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES FLAT MUSCLES: VERTICAL MUSCLES - From the pubic symphysis to the costal margin. - Intersected by transverse tendons. 3-4 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES - Small, triangular muscle. - Anterior to the rectus abdominis muscle. - It may be absent. - From the pubis to the L inea alba. FLAT MUSCLES: PYRAMIDALIS MUSCLES 1. Abdomen: abdominal wall ANTEROLATERAL MUSCLES FLAT MUSCLES: RECTUS SHEATH Upper ¾ of the rectus abdominis Inferior ¼ of the rectus abdominis 1. Abdomen: abdominal wall FLAT MUSCLES: RECTUS SHEATH 1. Abdomen: abdominal wall POSTERIOR WALL MUSCLES - Medial: Psoas major and minor muscles. - Lateral: Quadratum lumborum muscles. - Superior: Diaphragm. - Inferior: Iliacus muscles. 1. Abdomen: abdominal wall MEDIAL: POSTERIOR WALL MUSCLES PSOAS MAJOR AND MINOR MUSCLES Medially, the psoas major muscles cover the anterolateral surface of the bodies of the lumbar vertebrae, filling in the space between the vertebral bodies and the transverse processes. Associated with the psoas major muscle is the psoas minor muscle, which is sometimes absent. 1. Abdomen: abdominal wall MEDIAL: POSTERIOR WALL MUSCLES Laterally, the quadratus QUADRATUS LUMBORUM MUSCLES lumborum muscles fill the space between ribs XII and the iliac crest on both sides of the vertebral column. They are overlapped medially by the psoas major muscles; along their lateral borders muscles. are the transversus abdominis 1. Abdomen: abdominal wall POSTERIOR WALL MUSCLES Inferiorly, an iliacus muscle covers the iliac fossa on each side. The muscle passes inferior to the inguinal ligament, joins with the psoas major muscle, and passes into the thigh. These combined muscles are referred to as the iliopsoas muscle. INFERIOR: ILIACUS MUSCLES 1. Abdomen: abdominal wall INFERIOR: DIAPHRAGM The classic appearance of the right and left domes of the diaphragm is caused by the underlying abdominal contents pushing these lateral areas upward: •the liver on the right, with some contribution from the right kidney and the right suprarenal gland, and •the fundus of the stomach and spleen on the left, with contributions from the left kidney and the left suprarenal Drake RL, Vogl AW, Mitchell AWM, Tibbitts R, Richardson P. Gray ́s Atlas of Anatomy, gland.3rd Edition. 1. Abdomen: abdominal wall INFERIOR: DIAPHRAGM Structurally, the diaphragm consists of a central tendinous circumferentially part into arranged which muscle the fibers attach. The diaphragm is anchored to the lumbar crura, vertebrae which longitudinal by blend ligament musculotendinous with of the the anterior vertebral column. ■ The right crus is the longest and broadest of the crura and is attached to the bodies of vertebrae LI to LIII, and the intervening intervertebral discs. ■ Similarly, the left crus is attached to 1. Abdomen: abdominal wall INFERIOR: DIAPHRAGM 2 hiatus and 1 foramen: - Aortic hiatus: aorta artery, and the azygos vein. - Oesophageal hiatus: oesophagus. - Caval opening: Accompanying the inferior vena cava through the caval opening is the right phrenic nerve. The left phrenic nerve passes through the muscular part of the diaphragm just anterior to the central tendon on the left side. 1. Abdomen: peritoneum and peritoneal cavity The peritoneum is a thin membrane lines the walls of the abdominal cavity and covers much of the viscera. The parietal peritoneum lines the walls of the cavity and the visceral peritoneum covers the viscera. It delimits cavity. a serous Abdominal cavity: viscera peritoneal either are suspended in the peritoneal cavity by folds of peritoneum (mesenteries) or are outside the peritoneal cavity. Organs suspended in the cavity are referred to as intraperitoneal; organs outside the peritoneal cavity, with only one surface or 1. Abdomen: peritoneum and peritoneal cavity Intraperitoneal Retroperitoneal Subperitoneal Stomach 1st part of duodenum Jejunum Ileum Cecum Appendix Transverse colon Sigmoid colon Rectum (1st third) Liver Spleen Pancreas (tail) 2nd & 3rd parts of the duodenum Ascending colon Descending colon Rectum (2nd third) Pancreas Kidneys Suprarenal glands Ureter (proximal) Renal vessels Gonadal vessels Inferior cava vein Inferior aorta artery Rectum (distal third) Bladder Ureter (distal) Uterus Ovary Oviduct 1. Abdomen: peritoneum and peritoneal cavity Peritoneal folds that connect organs to each other or to the abdominal wall: OMENTA, MESENTERIES AND LIGAMENTS 1. Abdomen: peritoneum and peritoneal cavity OMENTA GREATER OMENTUM A large, apron-like, peritoneal fold that attaches to the greater curvature of the stomach and the first part of the duodenum. It covers inferiorly over the transverse, jejunum and ileum. It always contains an accumulation of fat and is highly vascularised. 1. Abdomen: peritoneum and peritoneal cavity OMENTA LESSER OMENTUM It extends from the lesser curvature of the stomach and the first part of the duodenum to the inferior surface of the liver. 1. Abdomen: peritoneum and peritoneal cavity MESENTERIES Peritoneal folds that attach viscera to the posterior abdominal wall. - Mesentery: small intestine - Mesocolon: large intestine. 1. Abdomen: peritoneum and peritoneal cavity LIGAMENTS Two layers of peritoneum that connect two organs to each other or attach an organ to the body wall, and may form part of an omentum. For example, the splenorenal ligament connects the left kidney to the spleen and the gastrophrenic ligament connects the stomach to the diaphragm. 1. Abdomen: inguinal region Area of junction between the anterior abdominal wall and the thigh. In this area, the abdominal wall is weakened and can therefore protrude through it, creating an inguinal hernia. 1. Abdomen: peritoneum and peritoneal cavity Processus vaginalis (peritoneal out-pouching): - Deepest covering: transversalis fascia. - Second covering: internal oblique. - The most superficial covering: aponeurosis of the external oblique. 1. Abdomen: peritoneum and peritoneal cavity The processus vaginalis forms the INGUINAL CANAL Downward and medial direction. - Above and ligament. parallel to the inguinal - Limited by a deep inguinal ring and a superficial inguinal ring. - Content: genital branch of the genitofemoral nerve, the spermatic cord in men, and the round ligament of the uterus in women. BIBLIOGRAP HY Drake RL, Vogl AW, Mitchell AWM. Gray's Basic Anatomy, 4th Edition. Philadelphia, PA: Elsevier, 2019. Drake RL, Vogl AW, Mitchell AWM, Tibbitts R, Richardson P. Gray ́s Atlas of Anatomy, 3rd Edition. Philadelphia, PA: Elsevier, 2020. Martini FH, Tallitsch RB, Nath JL. Human Anatomy. 8th Edition. Pearson Education SA, 2018. Sobotta. Atlas of Human Anatomy, 15th Ed. Elsevier Gmbh, Munich. Maria del Mar Ubero Martinez [email protected] UCAM Universidad Católica de Murcia © UCAM
