Abdominal Wall & Peritoneum
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Transcript of Abdominal Wall & Peritoneum
Abdominal wall
Objectives:• To know the anatomy of abdominal
wall( ant& post).• Blood supply nerve supply and lymph
drainage• To understand the anatomy of the inguinal
canal• To list common types of hernia
Abdomen is a closed cylinder with a musculo-skeletal wall.
Inside are the wall are the liver, intestines, kidneys, etc.
Abdominal Muscles Increase Intra-abdominal pressure
Remember Valsava?
Abdomen defined by diaphragm above, pelvic brim below, and vertebral bodies ribs and muscles posteriorly, and laterally.
To get in the abdominal cavity you must go through skin, 2 superficial fascias (fatty and membraneous). 3 muscles layers (or one), transversalis fascia, parietal peritoneum.
MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL
LINEA ALBA
TENDINOUSINTERSECTION
RECTUSABDOMINIS
INGUINAL LIGAMENT
TRANSVERSUS ABDOMINIS
INTERNAL OBLIQUE
EXTERNAL OBLIQUE
APONEUROSIS OFEXTERNALOBLIQUE
SUPERFICIALINGUINAL RING
MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL
RECTUS SHEATH
APONEUROSES
TA
IO
EO
BELOW THE ARCUATE LINE ALL APONEUROSES PASS IN FRONT OF THE RECTUS ABDOMINIS
ABOVE THE ARCUATE LINE THE APONEUROSIS OF THE INTERNAL OBLIQUE SPLITS TO ENCLOSE
THE RECTUS ABDOMINIS
Vessels of the Anterolateral Abdominal Wall
Internal thoracic vessels
Inferior epigastric vessels
Superior epigastric vessels
Nerves of the Abdominal Wall—Ventral Rami of T6 to L2
MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL
EXTERNAL OBLIQUE
BILATERAL ACTION:ASSISTS RECTUS ABDOMINISIN FLEXING VERTEBRALCOLUMN, COMPRESSING ABDOMINAL WALL, ANDINCREASING INTRA-ABDOMINAL PRESSURE
UNILATERAL ACTION:AID BACK MUSCLES INROTATION ANDLATERAL FLEXION
NN. = T7-T12
INTERNAL OBLIQUE
NN. = T7-T12, L1
MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL
RECTUS ABDOMINIS
RECTUSABDOMINIS
BILATERAL:FLEXION OF VERTEBRALCOLUMN, COMPRESSION OF ABDOMEN, INCREASE IN INTRA-ABDOMINALPRESSURE
UNILATERAL:ASSISTS BACK MUSCLES IN LATERAL FLEXION AND ROTATION
NN. = T7-T12, L1
Psoas and quadratus lumborum form posterior wall.
Psoas + Iliacus = Iliopsoas—Most Major Hip Flexor—Crosses under Inguinal Ligament with Femoral Nerve, and External Iliacs (become Femoral a and v.
Inguinal Ligament—inferior border of aponeurosis of external oblique muscle—attaches to ASIS and pubic tubercle
*
* Superficial Inguinal ring, a weak spot through which abdominal contents may extrude-direct inguinal hernia.
Deep Inguinal Ring—Pushes through transversalis faciaInginal Canal from deep ring (under ext. oblique) to superfical inguinal ring (where hernias puch out)
What’s indeed the parietal peritoneum?
Liver
Gall Bladder
Stomach
Ascending Colon
Small intestines
Greater Omentum—an apron from the stomach to the transvers colon.
The Abdominal CavityThe Abdominal Cavity
DOUBLE-LAYERED FOLDS OF PERITONEUMTHAT SUSPEND THE VISCERAL ORGANS.
PROVIDE A NEUROVASCULAR CONNECTION BETWEEN THE ORGANS AND THE BODY WALL
MESENTERIES
““The Mesentery”The Mesentery”
The Mesentery
• Greater omentum and transverse colon reflected—pulled up.
Figure 22.6c
The Mesentery attaches to the posterior wall.
Ileo-Colic junction
Duoduodnal-Jejunal junct
Duodenum
begins
Intraperitoneal Abdominal Organs derived from foregut (B) Intraperitoneal Abdominal Organs derived from foregut (B) have a dorsal and ventral mesentery. Midgut derived organs have a dorsal and ventral mesentery. Midgut derived organs
(A) lack a ventral mesentery.(A) lack a ventral mesentery.
A
A
B
B
Parietal peritoneum – Parietal peritoneum – serous membrane lining the abdominal serous membrane lining the abdominal cavity (space between)cavity (space between)
Visceral peritoneumVisceral peritoneum – – serous membrane covering the internal organsserous membrane covering the internal organs
Right and Left Colic Flexures
Some Organs Lose Their Mesentery Some Organs Lose Their Mesentery and Become Retroperitonealand Become Retroperitoneal
INTRAPERITONEAL VS.
RETROPERITONEALINTRAPERITONEAL ORGANS ARE ALMOST COMPLETELY COVERED WITH VISCERAL PERITONEUM
– THEY are suspended or protrude “in” into the peritoneal cavity, but are not actually in it.
RETROPERITONEAL ORGANS ARE LOCATED between the
paeietal perinoneum and the body wall itself. -They may be partially covered by parietal peritoneum
Subperitoneal—some organs lie below the peritoneum in the pelvis, e.g. The uterus and bladder.
PARIETAL PERITONEUM—Blue areaPARIETAL PERITONEUM—Blue area
MESENTERY PROPER
TRANSVERSEMESOCOLON
NOT SHOWN: MESOAPPENDIX, SIGMOID MESOCOLON
The Adult MesenteriesThe Adult Mesenteries
LESSER OMENTUM –A double layer of peritoneum extendingfrom the porta hepatisof the liver to the lessercurvature of the stomachand the beginning of the duodenum
GREATER OMENTUM –a double layer of peritoneumattached to the greatercurvature of the stomachsuperiorly and the transverse colon inferiorly; it hangs down like a fatty apron over theabdominal viscera
GREATER AND LESSER OMENTA
LESSER SAC OROMENTAL BURSA
GREATER SAC –SUPRACOLIC
GREATER SAC –INFRACOLIC
TWO PERITONEALSACS
TRANSVERSEMESOCOLON
Rotation of the Stomach Forms the Lesser Sac of the Rotation of the Stomach Forms the Lesser Sac of the Peritoneal Cavity and Starts to Form the Greater OmentumPeritoneal Cavity and Starts to Form the Greater Omentum
LOCATION OF THE SPLEEN
SPLEEN
The Peritoneum
The Peritoneum
The parietal peritoneum
The visceral peritoneum
The peritoneal cavity
kidneys
ureters
suprarenal glands
duodenum
pancreas
aorta
inferior vena cava
nerves
ascending colon
descending colon
The retroperitoneal space
The Peritoneum
The parietal peritoneum
The visceral peritoneum
The peritoneal cavity
The visceral peritoneum
The peritoneal cavity
1. The peritoneal ligaments
falciform ligament
ligamentum teres
median umbilical ligament
medial umbilical ligaments
lateral umbilical ligaments
2 layer folds of the peritoneum
1. The peritoneal ligaments
2. Lesser and Greater Omenta
3. The mesenteries
2. Lesser and Greater Omenta
Lesser and Greater Omenta
Lesser Omentum
hepatogastric ligament hepatoduodenal ligament
the epiploic foramen(of Winslow)
Greater Omentum
3. The mesenteries
The mesenteries
transverse mesocolon
sigmoid mesocolon
mesentery of the small intestine
Contents ?
Lesser Sac
Other Ligaments
Lesser Omentum
Greater Omentum
falciform ligament
ligamentum teres
phrenicocolic ligament
gastrocolic ligament
gastrophrenic ligament
gastrosplenic ligament
hepatogastric ligament hepatoduodenal ligament.
Lienorenal ligament
Lesser Sac
Lesser Sac
Lesser Sac
(Omental Bursa)
Morison’s pouch
left subhepatic space Vestibule
Superior recess
Lesser Sac
epiploic foramen (of Winslow)
Epiploic foramen (of Winslow)
Ant: hepatoduodenal ligament
Post: inferior vena cava
Sup: caudate lobe
Inf: first part of the duodenum
The supra-colic compartment
Peritoneal cavity
Greater sac
Rt. anterior subphrenic space Lt. anterior subphrenic space
Rt. posterior subphrenic(Rt. Subhepatic)
Morison’s pouch
left subhepatic Space(Lt. posterior subphrenic) Vestibule
Superior recess