Block Gastro 2012 Upper GI Tract
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Transcript of Block Gastro 2012 Upper GI Tract
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04/19/23Wahyuni Atmodjo 1
ABDOMINAL WALL
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Objectives
To define boundaries, quadrant and regions of abdomen
To describe the abdominal wall
To define layers of anterior abdominal wall
To define organization of the muscles
To describe innervation and vascularisation of the abdominal wall
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Superior Diaphragm
Inferior Pelvic inlet
Anterior and lateral Muscles
Posterior Lumbal vertebra Muscles
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Skin
Fat / Camper’s fasc
Scarpa’s fasc
M. OAE
M. OAI
M. Transversus abdominis
Transversal Fascia
Peritoneum parietale
Layers of abdominal wall
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Muscles of anterior abdominal wall EOM:
4th –12th riblinea alba IOM:
Inquinale lig, crista iliaca, fasc. Thoracolumbal 9th-12th ribs, linea alba, os pubis, linea pectinea
Transversus abdominis Inquinale lig, crista iliaca, fasc. Thoracolumbal
linea alba, os pubis, linea pectinea Rectus abdominis
Os pubis, interpubic lig cartilago 5th-7th ribs, proc. xiphoideus
Pyramidalis Os pubis, ant pubic lig linea alba
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Function Compress abdominal contents Protect abdominal injury Increase intra-abdominal
pressure Support respiration Flexion the trunk Rotate the trunk
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Muscles of post abdominal wall Iliopsoas mayor
Psoas head : Proc. Transversus VT12- L4 trochanter
minor femur Iliac head : illiac fossa trochanter minor
femur
Diaphragm Costal margin VL1-L4 central tendon
Quadratus lumborum Iliolumbar lig, crista iliaca posterior 12th rib,
proc transversus VL1-4
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Action M. quadratus lumborum:
Abduction coll vert Fixation 12th rib during inspiration Depression 12th rib during forced
expiration
M. iliopsoas: Flexion coll vert, the thigh when the leg
is not planted, flexion hip joint when the leg is planted
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Iliopsoas mayor Diaphragm Quadratus
lumborum
External Obligus Abdominis Internal Obligus Abdominis Transversus abdominis Rectus abdominis Pyramidalis
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Blood supply of abdominal wall
Epigastric arteries A. epigastrica superior (thoracica interna) A. epigastrica inferior (iliaca externa)
Intercostal arteries (aorta thoracalis) Deep circumflex iliac artery (iliaca
externa) Superficial epigastric artery (femoral)
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Blood supply
a. epigastrica sup
a. epigastrica inf
a. epigastrica superf
a. circumflexa iliaca profundus
a. circumflexa iliaca superfc
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VeinsDeep drainage
Paralel to the arterial supply
Superficial drainage Superior and inferior epigastric
veins Axillary vein Femoral vein Hepatic portal vein
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Nerves of abdominal wall
Rami ventralis N. spinalis Nn. Intercostalis inferior (T7 - T12)
Lateral cutaneous branch Anterior cutaneous branch
Plexus lumbalis (L1-L2) Anterior division
N. iliohypogastricus N. ilioinquinalis N. genitofemoralis
Posterior division Lateral femoral cutaneous
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DIGESTIVE SYSTEM
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DIGESTIVE SYSTEM
Mouth Pharynx Esophagus Stomach Small intestine : duodenum, jejenum, ileum Cecum and appendix Large intestine: colon ascendens, transversus,
descendens Sigmoid, Rectum, Anal canal, Anus Accessory organ: Liver, Pancreas, Spleen
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Localized the part of the abdomen
Describe the location of pain Indicating the location of viscera
General localisation (quadrant) Specific localisation (regio)
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Quadrant
RUQ (Right upper quadrant) Right lobe of liver, gallbladder, pylorus, duodenum,
pancreas, right supraren, right kidney
LUQ (Left upper quadrant) Left lobe of liver, spleen, stomach, jejenum and
ileum, pancreas, left supraren, left colic, transverse colon, descending colon
RLQ (Right lower quadrant) Cecum, appendix, ileum, ascending colon, r-ovary, r-
uterine tube, r-ureter, uterus, urinary bladder, r-spermatic cord
LLQ (Left lower quadrant) Sigmoid colon, descending colon, l-ovary, l-uterine
tube, l-ureter, l-spermatic cord, urinary bladder, uterine
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PlanePlaneVertical : Median planeVertical : Median planeHorizontal: Horizontal: Transumbilical planeTransumbilical plane
QuadrantQuadrantUpper leftUpper leftUpper rightUpper rightLower leftLower leftLower rightLower right
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Regions
For specific localisation of a finding, abdomen is devided into 9 regions
Epigastric/epigastrium RH : right hypochondriaca LH : left hypochondriaca Umbilical RL : right lumbar LL : left lumbar Hypogastric/hypogastrium RI : right inquinal LI : left inquinal
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Plane of the Regions
VerticalVerticalRight Right
midclavicularmidclavicularLeft Left
midclavicularmidclavicular
Horizontal:Horizontal:SubcostalSubcostal
TranstubercularTranstubercular
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Length 25 cm, diameter 2 cm
Behind the trachea Passes through
diaphragm at VT X Continue as cardia of
the stomach Has cardiac sphincter Function: transport of
food
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Position: left hypochondriaca - epigastric
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Structure of gaster
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• • greater curvature• lesser curvature,• cardiac sphincter,• fundus, • corpus, • anthrum pyloricum• pyloric sphincter• rugae, gastric sulci,• gastric glands
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Length: 25 cm Secondary retroperitoneal C shape
Division Superior (L1), Descending (L2-L3), Transverse (L3) Ascending (L3-L2)
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Location: umbilical region
Length : 2.4 m diameter : 2-4cm Thicker wall Vasa recta tall Arcades fewer Plica circularis tall Peyer patches few
Location : hypogastric region
Length: 3.6 m diameter: 2-3cm Thiner wall Vasa recta short Arcades many Plica circularis short Peyer patches many
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Blind pouch Location:
below ileocecal junctionright iliac fossa, above inq lig.
Ileocecal junction Ileal papilla:projection at
the point of entry Ileocecal valve:border
ileocecal ostium
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Retrocecal fossa: 65%
Iliac fossa: 31%
Right paracolic recess: 2%
Sup iliocolic fossa: 1%
Inf iliocolic fossa: 1%
Length : 8-9 cm Position: 2-3 cm Intraperitoneal, supported by mesoappendix
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Blood supply of esophagus
Arteries A. thyreoidea inferior A. esophageal A. bronchialis A. gastrica sinistra
Veins Azygos and hemiazygos vein Left gastric vein portal vein Esophageal venous
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Arteries Right gastric a : pylorus Gastroduodenal a : pylorus, corpus Left gastric a : fundus, cardi, corpus Short gastric a: fundus, corpus Gastroepiploic a: left corpus
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VASCULATURE Superior mesenteric
a. Inferior
Pancreaticoduodenal
Right gastric a. Gastroduodenal a.
Supraduodenal a. Retroduodenal a. Superior
pancreaticoduodenal a.
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Innervations of GI tract Parasymphatetic
Vagus Celiac plexus
Symphatetic Greater splanchnic nn. Celiac ganglia Celiac plexus
Afferent Sensory Referred pain
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Innervation
Parasymphatis: left and right vagus esophageal plexus
Symphatis : thoracic splanchnic n
Afferent Sensory thoracic and greater
splanchnic nerves
Referred pain epigastria region
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Clinical problems
Esophagitis gastric contents reflux into esophagus
heartburn Esophageal varices
portal hypertension Hiatus hernia
herniation of stomach through esophageal hiatus at diaphragm
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Clinical problems
Gastritis: excessive HCl Peptic ulcer
Location : Duodenum Complication: bleeding, peritonitis,
hematemesis Treatment: antacid, selective vagotomy
Malignant metastases
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Abdominal pain Gastritis
Epigastric pain Appendicitis
A generalized pain epigastric region umbilicus Right Lumbar quadrant
Peritoneitis Inflammation of the peritoneum Severe pain everywhere