the abdomen stuart m bunt functional anatomy 212

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The Abdomen Stuart M Bunt Functional Anatomy 212

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Page 1: The Abdomen Stuart M Bunt Functional Anatomy 212

The Abdomen

Stuart M Bunt

Functional Anatomy 212

Page 2: The Abdomen Stuart M Bunt Functional Anatomy 212

Overview

Page 3: The Abdomen Stuart M Bunt Functional Anatomy 212

Embryology Revision

Foregut, Midgut and Hindgut suspended by the dorsal mesentary, initially straight

Ventral mesentary connects stomach and ant. abd. wall, rest of gut free anteriorly

Mesentary supplies blood and nerves to gut between layers of peritoneum

Complex adult layout due to 270o rotation

Page 4: The Abdomen Stuart M Bunt Functional Anatomy 212

Blood Supply to Abdominal Organs Foregut

Celiac trunk Midgut

Superior mesenteric artery Hindgut

Inferior mesenteric artery Rectum

Internal iliac artery (pudendal and rectal arteries)

Page 5: The Abdomen Stuart M Bunt Functional Anatomy 212

Stomach Variable size and shape,

distensible J shaped related to body

form Lesser and greater

curvature gastroesophageal

junction fundus,cardiac part,

body, pyloric part pyloric antrum and

sphincter rugae and gastric pits

Page 6: The Abdomen Stuart M Bunt Functional Anatomy 212

Blood Supply of Stomach

Page 7: The Abdomen Stuart M Bunt Functional Anatomy 212

Superior Mesenteric Artery Territory

Page 8: The Abdomen Stuart M Bunt Functional Anatomy 212

Inferior mesenteric artery territory

Page 9: The Abdomen Stuart M Bunt Functional Anatomy 212

Venous system

Portal Vein Splenic vein

inferior mesenteric vein

Superior mesenteric vein

Gastric veins Hepatic Veins

Inf. Vena CavaInf. Vena Cava

Page 10: The Abdomen Stuart M Bunt Functional Anatomy 212

Anastomoses

Page 11: The Abdomen Stuart M Bunt Functional Anatomy 212

Stomach rotates and distends

Front

Back

OmentumOmentum

Dorsal Dorsal MesentaryMesentary

VentralVentralMesentaryMesentary

Splenic Splenic tissuetissue

Epiploic Foramen

Page 12: The Abdomen Stuart M Bunt Functional Anatomy 212

Omentum

Page 13: The Abdomen Stuart M Bunt Functional Anatomy 212

Under the OMENTUM

Page 14: The Abdomen Stuart M Bunt Functional Anatomy 212

The Peritoneal cavity is divided in two

Rotation of stomach forms the greater omentum(allows stomach distension and infection control)

Omental bursa or Lesser sac is inside omentum (a potential space)

Lesser omentum runs from stomach to liver(note free lower border above epiploic foramen

contains portal vein, hepatic artery and bile duct

Falciform ligament runs from liver to ant abd. wall

Page 15: The Abdomen Stuart M Bunt Functional Anatomy 212

Mesenteries are important:-

Paracolic gutters channel fuid Stop herniation due to bipedal posture Supply blood/nerves Sensitive to stretch Contain infection Useful in surgery

Page 16: The Abdomen Stuart M Bunt Functional Anatomy 212

On return some gut fuses with posterior wall

Rectum

Desc. ColonAsc. Colon

Duo.

12

3

41.lienorenal lig.2.trans. mesocolon3.mesentary proper4.mes. of sig. colon

Diaphragm

Page 17: The Abdomen Stuart M Bunt Functional Anatomy 212

Retro-peritoneal

Page 18: The Abdomen Stuart M Bunt Functional Anatomy 212

Oesophagus 10 inches from pharynx to stomach narrow

at cricoid cartilage where left bronchus crosses oesophageal hiatus in diaphragm

mucous membrane folded (normally collapsed) stratified squamous epithelium striated above smooth below trachea on right, lower aorta on left medial to L. lung, behind left atrium

Page 19: The Abdomen Stuart M Bunt Functional Anatomy 212

Duodenum

first 12 inches of gut four parts form C shape

duodenal cap radiologically identified, ulcers form here mobile

descending part pancreatic and bile ducts

horizontal part crosses psoas, IVC and aorta crossed by mesentery, sup mesen. art.

ascending part

Page 20: The Abdomen Stuart M Bunt Functional Anatomy 212

Jejunum 2/5ths of small

intestine gradual transition to

ileum many small villi increasing numbers of

lymph nodules no submucosal glands lacteals in each villus columnar epithelium

Page 21: The Abdomen Stuart M Bunt Functional Anatomy 212

Ileum

distal 3/5ths of intestine narrower, thinner, less

vascular, slower, more fat and arterial arcades

in mesentery than jejunum. Peyer’s patches of lymphoid

tissue

Page 22: The Abdomen Stuart M Bunt Functional Anatomy 212

Colon ascending colon

retroperitoneal right colic or hepatic

flexure transverse colon

(mesocolon) droops towards pelvis? left colic or splenic

flexure descending colon

retroperitoneal pelvic or sigmoid colon S

shaped

Page 23: The Abdomen Stuart M Bunt Functional Anatomy 212

Colonoscopy

Barium enema outlines structures on X-rays

Page 24: The Abdomen Stuart M Bunt Functional Anatomy 212

Appendix

Page 25: The Abdomen Stuart M Bunt Functional Anatomy 212

The Liver Largest Gland (one

of largest organs) Right upper

abdomen under diaphragm

Grows as outgrowth of gut plus mesoderm

Diaphragmatic surface

Visceral surface down and left related to

stomach, duodenum, r. kidney, r. colonic flexure

bears gall bladder

Page 26: The Abdomen Stuart M Bunt Functional Anatomy 212

Biliary System R and L Hepatic ducts Common hepatic duct Joined by cystic duct (to

gall bladder) Forms bile duct

(common bile duct) Gall Bladder

body and fundus, salts and water absorbed

store for bile, released in response to cholecystokinin

Page 27: The Abdomen Stuart M Bunt Functional Anatomy 212

Pancreas

Page 28: The Abdomen Stuart M Bunt Functional Anatomy 212

Pancreas

Head in concavity of duodenum body across vertebrae tail reaches the spleen pancreatic duct (+ accessory?) ampulla duodenal papilla

Page 29: The Abdomen Stuart M Bunt Functional Anatomy 212

Spleen

Page 30: The Abdomen Stuart M Bunt Functional Anatomy 212

The Spleen Lies in left hypochondriac region between

gastric fundus and diaphragm at level of 9th-10th rib (not normally palpable)

Soft, friable, highly vascular, dark purple Diaphragmatic surface

convex and smooth facing diaphragm Visceral surface

gastric, renal, pancreatic and colic impressions

Page 31: The Abdomen Stuart M Bunt Functional Anatomy 212

The Spleen (2)

Hilum of spleen long fissure through which vessels and nerves pass

Suspended from stomach by gastrolienal ligament (contains short gastric and left gastro-epiploic branches of spenic artery)

Suspended from posterior abdominal wall by lienorenal ligament

Covered by adherent peritoneum

Page 32: The Abdomen Stuart M Bunt Functional Anatomy 212

Relationship to the Spleen

Page 33: The Abdomen Stuart M Bunt Functional Anatomy 212

Kidneys

In fat capsule

Suprarenal glands superiorly

Direct Arterial and venous supply

Page 34: The Abdomen Stuart M Bunt Functional Anatomy 212

Kidney Internal Structure Renal pyramids

between renal columns

Renal Cortex Renal papillae

drain into minor calix

Major calix join to form renal pelvis

Ureter as outlet

Page 35: The Abdomen Stuart M Bunt Functional Anatomy 212

Kidneys External View

Artery - Vein - Ureter

Page 36: The Abdomen Stuart M Bunt Functional Anatomy 212

Relationships of the Kidneys