Abdomen Body Cavities Anatomy PDF

Abdomen Cheryl Purvis, Ph.D. Professor of Anatomy NSU MD  Abdomen Moore: Chapter 5 Netter: Abdomen Abdominal Cavity Abdominal Viscera Urinary System Antero...

Abdomen Cheryl Purvis, Ph.D. Professor of Anatomy NSU MD  Abdomen Moore: Chapter 5 Netter: Abdomen Abdominal Cavity Abdominal Viscera Urinary System Anterolateral Abdominal Wall Diaphragm Inguinal Canal Hernia Digestive System Portal Hepatic System  Learning Objective Identify contents of each of the abdominal quadrants. VISUALIZE To MEMORIZE 4e:268 6e:244 5e:242 Liver & Gallbladder Spleen Hepatic Flexure Splenic Flexure Cecum & Appendix Sigmoid Colon  Abdominal Quadrants RIGHT UPPER QUADRANT (RUQ) LEFT UPPER QUADRANT (LUQ) Liver: Right Lobe Liver: Left Lobe Gallbladder Spleen Stomach: pylorus Stomach Duodenum: parts 1-3 Jejunum / Proximal Ileum Pancreas: head Pancreas: body and tail Right suprarenal gland Left kidney Right kidney Left suprarenal gland Right colic flexure Left colic flexure Ascending colon: superior portion Transverse colon: left half Transverse colon: right half Descending colon: superior portion RIGHT LOWER QUADRANT (RLQ) LEFT LOWER QUADRANT (LLQ) Cecum Sigmoid colon Vermiform Appendix Descending colon: inferior portion Most of Ileum Left Ovary Ascending colon: inferior portion Left uterine tube Right Ovary Left ureter: abdominal part Right uterine tube Left spermatic cord: abdominal part Right ureter: abdominal part Uterus: if enlarged Right spermatic cord: abdominal part Urinary bladder: if very full Uterus: if enlarged Urinary bladder: if very full  Learning Objective Describe the structure and function of the muscles and fascia of the abdominal wall: Internal and External Obliques, Rectus Abdominus, Transverse Abdominus, Rectus Sheath, Linea Alba, and Umbilical Ring 4e:256 6e:252 5e:250  Vasculature: Superior epigastric a. (from internal thoracic a.) Inferior epigastric a. (from external iliac a.)  Abdomen – Structure List - Rectus abdominis m. Netter is Better - External abdominal oblique m. - Internal abdominal oblique m. - Transverse abdominis m.  Learning Objective Describe the inguinal canal and ring. 4e:260 6e:256 5e:254  Clinical Consideration: Descent of the TESTES Cryptorchidism Most of the time, a boy's testicles descend by the time he is 9 months old. Undescended testicles are common in infants who are born early. The problem occurs less in full-term infants. Undescended testicle increases the risk of infertility (not being able to have children), testicular cancer, hernias and testicular torsion (twisting). An empty scrotum also can cause significant psychological stress as the boy gets older. For these reasons, early treatment is very important.  Inguinal Hernias DIRECT INDIRECT Indirect inguinal Direct Inguinal hernias are a type hernias occur when of groin herniation, abdominal contents that arises from protrude through the protrusion of abdominal viscera deep inguinal ring, through a lateral to the inferior weakness of the posterior wall of epigastric vessels; this the inguinal canal may be caused by medial to the inferior epigastric failure of embryonic vessels, closure of the specifically processus vaginalis. through Hesselbach's triangle. Direct Versus Indirect Inguinal Hernia Direct Indirect Direct inguinal hernias are often Indirect inguinal hernias are caused by age-related stress and caused by a persistent opening weakened muscles in the that does not close during fetal inguinal canal. development.  4e:261 6e:----- 5e: ----- Thought you would like to see how bowel can herniate into the scrotum!  Hiatal Hernia Hiatal Hernia: Protrusion of any abdominal structure/organ into the thorax through a lax diaphragmatic esophageal hiatus. In 95% of cases, a portion of the stomach is herniated.  Umbilical Hernia Umbilical hernias occur when part of your intestine bulges through the opening in your abdominal muscles near your bellybutton (navel). Umbilical hernias are common and typically harmless. Umbilical hernias are most common in infants, but they can affect adults as well.  Learning Objective Describe the structure and function of the small intestine, mesentery, greater omentum, lesser omentum, and peritoneal ligament.  Peritoneum The peritoneum is a thin, transparent membrane that consists of 2 layers: Parietal peritoneum: lines abdominal wall Visceral peritoneum: covers abdominal viscera + forms serosa of organs  Mesentery Mesentery: double layer of peritoneum that encloses an organ and connects it to the abdominal wall. It changes names depending on the organ involved: (i.e. mesogastrium, transverse mesocolon, mesoappendix) 4e:348 6e:321 5e:323 Omentum: doubled- layered sheet of peritoneum that attaches the stomach to the abdominal wall or other abdominal organs Greater omentum: fat-laden fold of peritoneum that hangs down from the greater curvature of the stomach like an apron and connects the stomach with the diaphragm, spleen and the transverse colon. Lesser omentum: connects lesser curvature of the stomach and proximal part of the duodenum to the liver. Individually these connections are referred to as hepatogastric and hepatoduodenal ligaments. Greater Omentum Lesser Omentum  Peritoneal Ligament Peritoneal ligament: double layer of peritoneum that connects an organ to another organ or the abdominal wall. These ligaments contain vessels or remnants of vessels. Example: Falciform Ligament (ligamentum teres) – obliterated Umbilical vein carried OXYGENATED blood from mom to fetus Digestive System: Structure List Peritoneal folds & mesenteries: - Falciform ligament NETTER is BETTER - Ligamentum teres hepatis - Greater & lesser omentum - Coronary ligament  Epiploic foramen (Foramen of Winslow) Location: posterior to free edge of lesser omentum (hepatoduodenal ligament) Significance: communication with peritoneal cavity (greater sac) through Epiploic foramen BOUNDARIES of Foramen: - Posteriorly – IVC and right crus of diaphragm - Superiorly – Caudate lobe of the liver - Inferiorly – 1st (superior) part of duodenum - Anteriorly – hepatoduodenal ligament Portal Triad in Hepatoduodenal Ligament: - Portal vein (posteriorly) - Proper Hepatic artery (left) - Common bile duct (right)  4e:312 6e:292 5e:292 Digestive System Overview Anterior Abdominal Wall: Internal View Ligamentum Teres = Obliterated Umbilical VEIN Median Umbilical Ligament = Obliterated Urachus Medial Umbilical Ligaments = Obliterated Umbilical Arteries Median Umbilical Ligament = Obliterated Urachus Medial Umbilical Ligaments = Obliterated Umbilical Arteries  PRENATAL Circulation Umbilical VEIN Umbilical ARTERIES POST Natal Circulation  Learning Objective Identify the components of the gastrointestinal tract. (esophagus, stomach, small intestine, duodenum, jejunum, ileum, large intestine, cecum, appendix, rectum, anus).  4e:312 6e:292 5e:292 Digestive System Overview Digestive System – Structure List Esophagus  Learning Objective Describe the structure, function, and innervation of the diaphragm. Phrenic Nerve C3, 4, 5 Diaphragm: Muscular portion Central Tendon Hiatuses: Caval Esophageal Aortic Digestive System – Structure List Stomach: - Cardiac - Fundus - Body DRAW it to Know it - Pylorus - Pyloric sphincter - Greater & lesser curvature - Rugae 3 muscle layers: - Outer longitudinal - Middle circular - Innermost oblique UNIQUE Digestive System – Structure List Small intestine: DJI - Duodenum - Duodenal papilla DRAW it to KNOW it - Jejunum - Ileum - Ileocecal junction - Plica circularis Digestive System – Structure List Large intestine: - Cecum - Vermiform appendix - Ascending colon - Right colic/hepatic flexure - Transverse colon NETTER is BETTER - Left colic/splenic flexure - Descending colon - Sigmoid colon - Rectum - Haustra coli - Taenia coli - Epiploic appendages Ileocecal junction Vermiform Appendix Haustra Tenia – longitudinal m. Most Common location of the Appendix is RETROCECAL – Posterior to the cecum Thought Question What is a Fecalith? What is the significance? Digestive System Structure List Pancreas - main pancreatic duct - Duodenal papilla - Common Bile Duct  4e:273 6e:267 5e:265 NOTE DEPTH Perceptions  Digestive System – Structure List Liver and biliary system: - Right & left lobe of liver - Bare area of liver - Quadrate lobe of liver DRAW it to KNOW IT - Caudate lobe of liver - Gall bladder - Right & left hepatic ducts KNOW the FLOW - Common hepatic duct - Cystic duct - Common bile duct KNOW the FLOW PORTAL SYSTEM LIVER 4e:300 6e:283 5e:283  Learning Objective Describe the structure and function of the biliary ducts and gallbladder. Biliary Tree KNOW the FLOW LIVER D u O D E N U m  Learning Objective Identify the spleen, pancreas, and liver. 4e:300 6e:283 5e:283 4e:273 6e:267 5e:265 PANCREAS The regions of the pancreas help you remember the location of major organs: HEAD of the Pancreas lies in the Arms of the DUODENUM. Body of the Pancreas lies in the bed of the STOMACH. SPLEEN gets a piece of TAIL.  Learning Objective Describe the structure, function, and innervation of the diaphragm. Phrenic Nerve C3, 4, 5 4e:231 6e:228 5e:225  Learning Objective Identify the arterial supply and venous drainage of the gastrointestinal tract. 4e:406 6e:384 5e:386 Vasculature: Major Arterial Supply DRAW it to KNOW it Abdominal aorta: - Celiac trunk - Superior Mesentery Artery - Inferior Mesentery Artery Gut Tube Blood Supply GUT TUBE Blood Supply FOREGUT Celiac Trunk MIDGUT SMA (Superior Mesenteric Artery) HINDGUT IMA (Inferior Mesenteric Artery)  Embryology of the Gut Tube FOREGUT MIDGUT HINDGUT Cranial portion of GI tract Begins at 2nd portion of duodenum Begins at left colic flexure Ends at the 2nd portion of Ends at proximal 2/3 of transverse (distal 1/3 of transverse colon) duodenum where bile duct enters. colon (left colic flexure) Ends at upper part of anal canal Forms: Forms: Forms: Esophagus Duodenum (2nd, 3rd, 4th) stomach Transverse colon (distal 1/3) Jejunum and ileum duodenum (1st + 2nd parts) Descending colon Cecum and Appendix liver Sigmoid colon Transverse colon (proximal 2/3) pancreas Rectum biliary passages Anal canal (upper part) gallbladder  Clinical Consideration: Embryological Development Intestinal malrotation: Arrest in normal rotation of gut in utero, resulting in abnormal orientation of bowel and mesentery within the abdominal cavity. Midgut volvulus: Torsion of malrotated midgut causing mechanical bowel obstruction Image Ref: slideshare.net Mostly in neonates and infants Thought Question: What is the Blood Supply to the MIDGUT? Image Ref: SprinkerLink Torsion > Ischemia! Vasculature: DETAILS Abdominal aorta : 1. Celiac trunk & branches: a. Splenic a. DRAW it b. Left gastric a. c. Common hepatic a. i. Gastroduodenal a. ii. Proper hepatic a. 2. Superior mesentery a. & branches: MRI to KNOW it a. Ileocolic a. b. Right colic a. c. Middle colic a. 3. Inferior mesentery a. & branches: LSS a. Left colic a. b. Sigmoidal a. c. Superior rectal a. 4. Lumbar aa. 5. Renal aa. 6. Gonadal aa. 4e:300 6e:283 5e:283 Superior Mesenteric Artery: Inferior Mesenteric Artery: MRI LSS - Middle Colic - Left Colic - Right Colic - Sigmoid - Ileocolic - Superior Rectal Vasculature: Inferior Vena Cava DRAW it to KNOW it Inferior vena cava 1. Right & Left Common Iliac vv. 2. Lumbar vv. 3. Renal vv. 4. Right gonadal v. (Note: left gonadal v. drains into the left renal v.) 5. Hepatic vv. Compare and contrast gonadal veins. Clinical Significance? 4e:406 6e:384 5e:386 Location LOCATION Renal Veins? Gonadal Veins? Ureters? KNOW the Flow Compare and Contrast the CAVAL System and the Portal System 4e:406 6e:384 5e:386 Visualize the Inferior Vena Cava Vasculature: Hepatic PORTAL Vein Hepatic portal system: SIS Splenic v. Inferior mesenteric v. DRAW it to KNOW it Superior mesenteric v. Hepatic Portal Vein Hepatic veins Inferior Vena Cava 4e:311 6e:291 5e:291 Hepatic Portal System IN SITU 4e:312 6e:292 5e:292 Hepatic Portal System BETTER NETTER Compare Portal System and Caval System Portal System Caval System  Learning Objective Identify major lymphatic vessels of the abdominal cavity. 4e:406 6e:384 5e:386  Learning Objective Summarize the autonomic innervation of the abdominal viscera.  SHOW ANS TIME System  Gut Tube Innervation and Blood Supply Blood Supply Parasympathetic Sympathetic Celiac Trunk VAGUS Greater Splanchnic (T5-T9) FOREGUT SMA VAGUS Lesser Splanchnic (T10 –T11) MIDGUT (Superior Mesenteric Artery) IMA Pelvic Splanchnic (S2,3,4) Lumbar splanchnic (L1-L2) HINDGUT (Inferior Mesenteric Artery) Innervation of the Small Intestine Innervation of the Large Intestine Autonomic Innervation of Intestines: Schema Autonomic Reflex Pathways: Schema Autonomic Innervation of the Liver: Schema Autonomic Innervation of Pancreas: Schema  Learning Objective Identify the kidneys, ureters, and adrenal glands. Anterior Relations of Kidneys  Urinary System: Structure List External features of kidney: - Position of right and left kidney - Renal pelvis - Renal hilus DRAW it to KNOW it - Renal artery and vein - Ureter HOMEWORK SHOW Assignment TIME URINARY SYSTEM