Dr. Ahmed Fathalla Ibrahim. ABDOMINAL VISCERA FOR EACH PART YOU MUST KNOW: 1.SURFACE ANATOMY...
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Transcript of Dr. Ahmed Fathalla Ibrahim. ABDOMINAL VISCERA FOR EACH PART YOU MUST KNOW: 1.SURFACE ANATOMY...
![Page 1: Dr. Ahmed Fathalla Ibrahim. ABDOMINAL VISCERA FOR EACH PART YOU MUST KNOW: 1.SURFACE ANATOMY 2.RELATIONS 3.PERITONEAL COVERING 4.BLOOD SUPPLY 5.NERVE.](https://reader034.fdocuments.us/reader034/viewer/2022042702/56649cd95503460f949a1da6/html5/thumbnails/1.jpg)
Dr. Ahmed Fathalla Ibrahim
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ABDOMINAL VISCERAABDOMINAL VISCERA
FOR EACH PART YOU MUST KNOW:FOR EACH PART YOU MUST KNOW:1.1. SURFACE ANATOMYSURFACE ANATOMY2.2. RELATIONSRELATIONS3.3. PERITONEAL COVERINGPERITONEAL COVERING4.4. BLOOD SUPPLYBLOOD SUPPLY5.5. NERVE SUPPLYNERVE SUPPLY6.6. LYMPHATIC DRAINAGELYMPHATIC DRAINAGE7.7. SUPPORT (IN SOME PARTS)SUPPORT (IN SOME PARTS)
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SMALL INTESTINESMALL INTESTINE
• DUODENUM: fixed part
• JEJUNUM & ILEUM: movable part (with mesentery)
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JEJUNUM & ILEUMJEJUNUM & ILEUM• Length: Length: 6 meters (20 feet)• Beginning: Beginning: duodenojejunal flexure• Termination: Termination: ileocecal junction• Embryological origin:Embryological origin: midgut• Peritoneal fold: Peritoneal fold: mesentery of small intestine• Arterial supply:Arterial supply: jejunal & ileal branches of superior superior
mesentericmesenteric• Lymphatic drainage:Lymphatic drainage: superior mesentericsuperior mesenteric lymph
nodes• Nerve supply:Nerve supply: superior mesentericsuperior mesenteric plexus:
sympathetic & parasympathetic (vagus)
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MESENTERY OF SMALL INTESTINEMESENTERY OF SMALL INTESTINE
• Extent:Extent: from duodenojejunal flexure to ileocecal junction
• Formation:Formation: formed of 2 layers • Free border (6 meters long):Free border (6 meters long): encloses
jejunum & ileum• Root (6 inches long, J-shaped):Root (6 inches long, J-shaped): crosses
superficial to the following structures:1.1. Third part of duodenumThird part of duodenum2.2. Abdominal aortaAbdominal aorta3.3. Inferior vena cavaInferior vena cava4.4. Right psoas majorRight psoas major5.5. Right ureterRight ureter
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MESENTERY OF SMALL INTESTINEMESENTERY OF SMALL INTESTINE• Shape: Shape: Fan-shaped with undulations
• Content of root:Content of root: superior mesenteric vessels
• Contents (structures between its 2 layers):Contents (structures between its 2 layers):
1.1. Jejunal vessels:Jejunal vessels: form few arcades
2.2. Ileal vessels:Ileal vessels: form many arcades
3.3. Mesenteric lymph nodesMesenteric lymph nodes
4.4. Autonomic nerve fibersAutonomic nerve fibers
5.5. Mesenteric fatMesenteric fat
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MESENTERY OF SMALL INTESTINEMESENTERY OF SMALL INTESTINE
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JEJUNUMJEJUNUM
1.1. Length:Length: shorter (proximal 2/5)2.2. Diameter:Diameter: wider3.3. Wall:Wall: thicker (more numerous plicae
circulares: circular folds of mucosa)4.4. Appearance:Appearance: more red in color (more
vascular)5.5. Vessels:Vessels: less arcades, long terminal
branches6.6. Mesenteric fat:Mesenteric fat: small amount near
intestinal border7.7. Aggregations of lymphoid tissue:Aggregations of lymphoid tissue: few
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ILEUMILEUM1.1. Length:Length: longer (distal 3/5)2.2. Diameter:Diameter: narrower3.3. Wall:Wall: thinner (less numerous plicae
circulares: circular folds of mucosa)4.4. Appearance:Appearance: light red in color (less vascular)5.5. Vessels:Vessels: more arcades, short terminal
branches6.6. Mesenteric fat:Mesenteric fat: large amount near intestinal
border7.7. Aggregations of lymphoid tissue:Aggregations of lymphoid tissue: numerous
(Peyer’s patches)
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LARGE INTESTINELARGE INTESTINEPARTS:1. Cecum2. Appendix3. Ascending colon4. Transverse colon5. Descending colon6. Sigmoid (pelvic) colon7. Rectum8. Anal canal9. N.B.: Parts of large intestine in abdomen:Parts of large intestine in abdomen:
from 1 to 5
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LARGE INTESTINELARGE INTESTINE
CHARACTERISTICS:CHARACTERISTICS:
1.1. Teniae coli:Teniae coli: 3 longitudinal muscle bands
2.2. Sacculations (haustrations):Sacculations (haustrations): teniae coli are shorter than large intestine
3.3. Appendices epiploicae:Appendices epiploicae: short peritoneal fold filled with fat
• N.B.: characteristics are present in all large intestine EXCEPT: in rectum & anal in rectum & anal canalcanal
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LARGE INTESTINELARGE INTESTINE• Embryological origin:Embryological origin:1.1. From midgut: From midgut: cecum, appendix, ascending colon,
right 2/3 of transverse colon2.2. From hindgut: From hindgut: left 1/3 of transverse colon,
descending & sigmoid colon, rectum, upper half of anal canal
• Peritoneal fold: Peritoneal fold: 1.1. Appendix, transverse & sigmoid colon:Appendix, transverse & sigmoid colon: have
mesentery2.2. Cecum:Cecum: completely covered by peritoneum, but has
no mesentery3.3. Ascending & descending colon:Ascending & descending colon: covered anteriorly
& on the sides4.4. Rectum & anal canal:Rectum & anal canal: discussed later
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LARGE INTESTINELARGE INTESTINE• Arterial supply:Arterial supply: 1.1. Midgut:Midgut: colic branches of superior mesenteric superior mesenteric 2.2. Hindgut: inferior mesentericHindgut: inferior mesenteric• Lymphatic drainage:Lymphatic drainage: 1.1. Midgut: superior mesentericMidgut: superior mesenteric lymph nodes2.2. Hindgut: inferior mesenteric Hindgut: inferior mesenteric lymph nodes• Nerve supply:Nerve supply: 1.1. Superior mesentericSuperior mesenteric plexus: sympathetic &
parasympathetic (vagus)2.2. Inferior mesentericInferior mesenteric plexus: sympathetic &
parasympathetic (pelvic splanchnic nerves)
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LARGE INTESTINELARGE INTESTINESURFACE ANATOMYSURFACE ANATOMY
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APPENDIXAPPENDIX
• Surface anatomy:Surface anatomy: the base of appendix is marked by Mc’Burney’s Mc’Burney’s pointpoint: A point at the junction of lateral 1/3 & medial 2/3 of a line traced from right anterior superior iliac spine to umbilicus
• Opening:Opening: at posteromedial aspect of cecum, 1 inch below ileo-cecal junction
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APPENDIXAPPENDIX
• Positions: (from Positions: (from most to least most to least common)common)
1.1. RetrocecalRetrocecal: most common position
2.Pelvic
3.Subcecal
4.Preilieal
5.Postileal
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CECUM, ASCENDING & CECUM, ASCENDING & DESCENDING COLONDESCENDING COLON
• ANTERIOR RELATIONS:ANTERIOR RELATIONS:
1. Coils of small intestine
2. Greater omentum
3. Anterior abdominal wall
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1: Iliohypogastric nerve; 2: Ilioinguinal nerve; 3: lateral cutaneous nerve of thigh4: Femoral nerve; 5: Genitofemoral nerve; 6: Obturator nerveP.M.= psoas major; Q.L.=quadratus lumborum; I.=iliacus; T.A.= transversus abdominis
1
2
3 4
5
6
Iliac crest
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1: Iliohypogastric nerve; 2: Ilioinguinal nerve; 3: lateral cutaneous nerve of thigh4: Femoral nerve; 5: Genitofemoral nerve; 6: Obturator nerveP.M.= psoas major; Q.L.=quadratus lumborum; I.=iliacus; T.A.= transversus abdominis
1
2
34
5
6
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CECUM, ASCENDING & CECUM, ASCENDING & DESCENDING COLONDESCENDING COLON
• POSTERIOR RELATIONS:POSTERIOR RELATIONS:• Cecum: Cecum: psoas major, genitofemoral nerve,
iliacus, lateral cutaneous nerve of thigh, femoral nerve
• Ascending colon: Ascending colon: iliacus, lateral cutaneous nerve of thigh, quadratus lumborum, ilioinguial nerve, iliohypogastric nerve, iliac crest, origin of transversus abdominis from lumbar fascia
• Descending colon: relations of cecum + Descending colon: relations of cecum + relations of ascending colon + left kidneyrelations of ascending colon + left kidney
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RELATIONS OF RELATIONS OF TRANSVERSE COLONTRANSVERSE COLON
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RELATIONS OF RELATIONS OF TRANSVERSE COLONTRANSVERSE COLON
• ANTERIOR:ANTERIOR: greater omentum, anterior abdominal wall
• POSTERIOR:POSTERIOR: 2nd part of duodenum, head of pancreas, coils of small intestine
• SUPERIOR:SUPERIOR: liver, gall bladder, stomach
• INFERIOR:INFERIOR: coils of small intestine