abdomen
TRANSCRIPT
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ABDOMENNORZULAIKA BINTI ALIAS
PENGAJAR JURUPULIH PERUBATAN ANGGOTA
HAS 1033,ANATOMY II
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Outlines
Identify the bony framework of abdomen
Know the abdominal cavity and its contents
Identify the regions and quadrants of abdomen
Recognize the muscles of the abdominal wall
Identify the nerves of the abdominal wall.
Know the common problems of abdomen
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ABDOMINAL CAVITY
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Abdominal cavity the major part of the abdominopelvic cavity.
located between the diaphragm and the pelvic inlet.
separated from the thoracic cavity by the thoracic diaphragm.
continuous inferiorly with the pelvic cavity.
under cover of the thoracic cage superiorly.
extends superiorly into the osseocartilaginous thoracic cage to the 4th intercostal space.
supported and partially protected inferiorly by the greater pelvis.
enclosed anterolaterally by multi-layered , musculoponeurotic, abdominal walls.
superior space:spleen,liver,part of kidney,stomach are protected by thoracic cage
lower abdominal viscera:part of ileum,cecum and sigmoid colon.
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Abdominal cavity
thin,slippery double-layered membranes
cover the viscera within the thoracic and abdominal cavities and lines the wall of them
2 parts:
parietal layer:lines the wall of the cavities
visceral layer:covers and adheres to the organs within the cavities
serous fluid:reduces friction,allows the slide of viscera eg.during breathing.
pleura:serous membrane in the pleural cavities
visceral pleura clings to the surface of the lungs
parietal pleura lines the chest wall
pleural cavity:in between
SEROUS MEMBRANE
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Abdominal cavity
pericardium:serous membrane of the pericardial cavity
visceral pericardium covers the surface of the heart
parieral pericardium lines the heart
pericardial cavity:in between
peritoneum:serous membrane of the abdominal cavity
visceral peritoneum covers the abdominal viscera
parietal peritoneum lines the abdominal wall
peritoneal cavity:in between of them
retroperitoneal organs:located behind the parietal peritoneum such as kidneys,adrenal glands,pancreas,duodenum,ascending and descending colons of the large intestine and portions of the abdominal aorta and inferior vena cava.
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Abdominal cavity
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Abdominal cavityRetroperitoneal organs are located in retroperitoneal cavity.
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Retroperitoneal organs
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Abdomen regions
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Abdominal regions
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Abdomen regions
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Abdominal regions
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Abdominal regions
midclavicular planes:from the midpoint of the clavicles to the midinguinal points
semilunar lines:shallow grooves of the lateral borders of the rectus abdominis
subcostal planes:inferior border of the 10th costal cartilage on each side
transtubercular plane:iliac tubercles and the body of the L5 vertebrae.
transpyloric plane:extrapolated midway between the superior borders of the manubrium of the sternum and the pubic symphysis.
interspinous plane:ASIS of each side
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Abdominal quadrants
LUQRUQ
RLQ LLQ
Median plane
Transumbilical plane
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Abdominal quadrants transumbilical plane:the umbilical (and the IV disc between L3 and
L4 vertebrae)
median plane:longitudinally throught the body
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Abdominal quadrants
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Muscles of the abdomen1)The anterolateral abdominal wall
consists of:
Rectus abdominis
Transverse abdominal
Internal oblique
External oblique
2)Functions of anterolateral abdominal muscles:
protect the abdominal viscera
move the vertebral column
assist in forced expiration,defecation,
urination and childbirth.
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Rectus abdominis
definition
-a long muscle that extends the entire length of the abdominal wall
-ant.surface has 3 transverse fibrous bands of tissue called tendinous intersections
originpubic crest and pubic symphysis
insertioncartilage of 5th to 7th ribs and xiphoid process
action
flexes trunk(lumbar vertebrae),compress abdomen to aid in defecation, urination, forced exhalation and childbirth, stabilizes and controls tilt of pelvis
innervation thoracic spinal nerves T7-T12
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Rectus abdominis
Rectus abdominis
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Rectus abdominis
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Transverse abdominal
definition
deep muscle,fascicles directed transversely around the abdominal wall
origin
iliac crest,inguinal ligament,lumbar fascia and cartilages of inferior six ribs
insertionxiphoid process,linea alba and pubis
action compresses and supports abdominal viscera
innervation
thoracic spinal nerves T8-T12,iliohypogastric nerve and ilioinguinal nerve
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Transverse abdominal
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Internal oblique
definition
intermediate ms,fascicles extend at right angles to those of the external oblique
originiliac crest,inguinal ligament and thoracolumbar fascia
insertioncartilage of last 3 or 4 ribs and linea alba
action
compress and support abdominal viscera,flex and lat. flex and rotate trunk
innervation
thoracic spinal nerves T8-T12,iliohypogastric nerve and ilioinguinal nerve
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Internal oblique
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External oblique
definitionsuperficial ms,fascicles extend inferiorly and medially
origin inferior 8 ribs
insertion iliac crest and linea alba
action
compress and support abdominal viscera,flex and lat.flex and rotate trunk
innervation thoracic spinal nerves T7-T12 and iliohypogastric nerve
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External oblique
External oblique
Inguinal ligament
Rectus sheath(ant.layer)
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Rectus sheath,linea alba and umbilicus
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Rectus sheath,linea alba and umbilicus
Rectus sheath
-is formed by the aponeurosis of the external oblique,internal oblique and transverse abdominis muscles.
-enclose the rectus abdominis ms.
Linea alba
-a tough ,fibrous band that extends from the xiphoid process of the sternum to the pubic symphysis
-a point where the rectus sheath meets and contains the umbilical ring
Umbilicus
-a defect in the linea alba through which the fetal umbilical vessels passed to and from the umbilical cord and placenta
-point where all the anterolateral abdominal wall fuse.
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Rectus sheath,linea alba and umbilicus
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Rectus sheath,linea alba and umbilicus
umbilical
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Muscles of the posterior abdominal wall
1)The posterior abdominal wall consists of:
Psoas major:long,thick,fusiform muscle passing inferolaterally to the lumbar vertebrae
Iliacus:large triangular ms. along the lateral sides of the inferior part of psoas major
Quadratus lumborum:thick ms.sheet adjacent to the transverse processes of the lumbar vertebrae and lat. to the sup. parts of the psoas major.
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Muscles of the posterior abdominal wall
Posterior view
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Psoas major
Origin Transverse processes and bodies of lumbar vertebrae
Insertion With iliacus into lesser trochanter of femur
Action Flex and rotate thigh laterally, flex trunk as in sitting up from supine position.
Innervation Lumbar spinal nerves L2-L3
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IliacusOrigin Iliac fossa and sacrum
Insertion With psoas major into lesser trochanter of femur
Action Flex and rotate thigh laterally, flex trunk as in sitting up from supine post
Innervation Femoral nerve
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Quadratus lumborum
Origin Iliac crest and iliolumbar ligament
Insertion Inf.border of 12th rib and first four lumbar vertebrae
Action -pull 12th ribs inferiorly during forced exhalation-fix 12th ribs to prevent their elevation during deep inhalation-extend lumbar -flex laterally vertebral column(lumbar)
Innervation
Thoracic spinal nerve T12 and lumbar spinal nerves L1-L3 or L1-L4
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Quadratus lumborum
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Nerves of the anterolateral abdominal wall
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Nerves of the anterolateral abdominal wall
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Nerves of the anterolateral abdominal wall
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Nerves of the posterior abdominal wall
Femoral nerve(L2-L4)
Obturator nerve(L2-L4)
Lumbosacral trunk(L4,L5)
Ilioinguinal and iliohypogastric nerves(L1)
Genitofemoral nerve(L1,L2)
Lateral cutaneous nerve of the thigh or lat.femoral cutaneous nerve(L2,L3)
Accessory obturator nerve(L3,L4)
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Nerves of the posterior abdominal wall
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Nerves of the posterior abdominal wall
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Contents of abdominal cavity
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Contents of abdominal cavity
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Contents of abdominal cavity
Digestive organs
-stomach,small intestine,large intestine, liver, pancreas, gallbladder
Spleen
Kidney
Adrenal(suprarenal gland)
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Intraperitoneal organs
Intraperitoneal organs are completely covered by visceral peritoneum
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Stomach Has 4 regions:
-cardia: surrounds the superior opening of the stomach.
-fundus: rounded portion sup. to and left of the cardia
-body: large central portion of stomach, inf. to fundus
-pylorus: connects stomach to duodenum.
Functions:
-mixes saliva,food and gastric juice to form chyme.
-serves as a reservoir for food before release into small intestine.
-secretes gastric juice,pepsin,intrinsic factor and gastric lipase.
-secretes gastrin into blood.
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Liver
It is divided into 2 lobes:
-large right lobe
-smaller left lobe:quadrate lobe and caudate lobe.
Is divided by the falciform ligament
Round ligament(ligamentum teres)-remnant of the umbilical vein of the fetus
Coronary ligaments: narrow extensions of the parietal peritoneum that suspend the liver from the diaphragm.
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Ileum
The final and longest region of the small intestine.
About 2 m long
Joins the large intestine at the ileocecal sphincter.
is composed of 4 layers:mucosa,submucosa,muscularis and serosa
Functions:
-mixes chyme with digestive juices
-complete the digestion of carbohydrates,proteins and lipids.
-begin and complete the digestions of nucleic acid
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Retroperitoneal organs
Organs outside the peritoneal cavity.
Partially covered with peritoneum
Kidneys, pancreas, duodenum, ascending and descending colon and rectum.
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Kidney
Pair of reddish, kidney-bean-shaped organs
Located above the waist between the peritoneum and the posterior wall of the abdomen.
Located between the levels of the last thoracic and third lumbar vertebrae, protected by the 11th and 12th ribs
Right kidney is lower than the left because the liver occupies space on the right kidney.
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Kidney
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Pancreas
It lies post. to the greater curvature of the stomach
Consists of head, body and tail.
It is connected to duodunem by 2 ducts.
Has 2 larger ducts:
-pancreatic duct
-accessory duct.
Functions
-secretes pancreatic juice that enters the duodenum
-secretes glucagon and insulin that enters the blood
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Pancreas
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Duodenum
The shortest region in the small intestine.
It starts at the pyloric sphincter of the stomach and extends about 25cm until it merges with the jejunum
Means 12,its long as the width of 12 fingers.
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Large intestine
ascending and descending colon and rectum.
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Large intestine Ascending colon: ascends on the right side of the abdomen, reaches the inferior
surface of the liver and turns abruptly to the left to form the right colic(hepatic) flexure.
Descending colon: at the level of iliac crest
Rectum: the last in GI tract, lies ant. to the sacrum and coccyx.
The terminal of rectum is called anal canal.
The opening of anal canal is called anus.
Functions:
-drives the contents of the colon into the rectum.
-converts proteins into amino acids
-absorbs water,ion,vitamins.
-forms feces
-discharges feces from the rectum.
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Common abdominal problems Abdominal hernia(rupture)
-occur at the anterolateral abdominal wall.
-mostly occur in the inguinal,umbilical and epigastric region.
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Inguinal hernia Protrusion of parietal peritoneum and viscera, such as the small intestine,
through a normal or abnormal opening from the cavity in which they belong.
They can be returned to their normal place in the peritoneal cavity by appropriate manipulation.
Constitutes between 80% -90% of abdominal hernias
Two types: direct and indirect inguinal hernias.
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Umbilical hernia
Common in newborns because the ant. abdominal wall is weak in the umbilical ring
Results from increased intra-abdominal pressure in the presence of weakness and incomplete closure of the ant. abdominal wall after ligation of the umbilical cord at birth.
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Acquired umbilical hernias
Occur commonly in women and obese people
Extraperitoneal fat and/or peritoneum protrude into the hernial sac.
The lines along which the fibers of the abdominal aponeuroses interlace.
Gaps(fiber exchanges) such as in the midline or in the transition from aponeurosis to rectus sheath.
They may be congenital, the result of the stresses of obesity or aging, complications of surgery or traumatic wounds.
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Epigastric hernia
Occurs in the midline between the xiphoid process and the umbilicus
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Spigelian hernia
Occurs along the semilunar lines
Affects in people>40 years and associated with obesity.
Hernial sac, composed of peritoneum is covered with only skin and fatty subcutaneous tissue.
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Thank you