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Abdominal wall

ANATOMY DEPARTMENT

Surface Anatomy - Landmar


ks Abdominal Wall

Umbilicus
Linea Alba

White line
Tendinous
Xiphoid process to p
ubic symphysis

Linea Semilunaris

Inskripsio tendinea

Anterior wall
Layers ( from superficial to deep)

Skin
Superficial fascia
Anterolateral muscles
Transversalis fascia
Extraperitoneal fascia
Parietal peritoneum

Anterior wall

Processus
Xiphoideus
Costal margin

Linea alba
Linea
semilunaris
SIAS

Anterior wall
Structures :

Linea alba

Inskripsio tendinea

Linea semilunar

Inguinal ligament

Muscles of abdomen
Anterolateral group

Obliquus externus abs


ominis
Oblequus enternus ab
dominis
Transversus abdomini
s
Rectus abdominis

Muscles of the Anterior Wall

4 Muscles

3 flat muscles that are continuous with the intercostal m


uscles
1 straplike muscle in a sheath produced by the aponeur
osis of the 3 flat muscles
Fibers run in different directions for increased strength
Protection to abdominal viscera
Movement of the trunk, forced ventilation, increase abd
ominal pressure
Innervation by intercostal nerves

Rectus abdominis

Position: lie on to either of midli


ne
Origin: pubic crest and symphys
is
Insertion: xiphoid and 5th-7th c
ostal cartilages
Has 3-4 tendinous intersection
s (inskriptio tendinea)
linea semiluaris

M. Psoas major (m. Iliopsoa


s)
Origo = lumbar vertebrae and T
12
Insersio = trochanter minor fem
ur via tendo m. iliopsoas
fungsi = flexion of thigh, trunk,
and lateral flexion of trunk
M. Quadratus lumborum
Origin = iliac crest and transver
se processes lower lumbar vert
ebrae
Insertion = transverse processe
s upper lumbar
Function = lateral flexion (alon
e), stability of spine (together)

Posterior group

10

Abdominal Regions

2 Vertical lines midclavicular


Transpyloric line inferior cost
al margin
Transtubercle line tubercles o
f iliac crests

Abdominal Regions

Right Hypochondriac

Epigastric

Stomach, liver, transverse colo


n

Right Lumbar

Stomach, liver, transverse colo


n

Left Hypochondriac

Gall bladder and liver

Ascending colon

Umbilical

Small intestine, transverse colo


n

Abdominal Regions

Left Lumbar

Right Inguinal (iliac)

Cecum, appendix

Pubic (hypogastric)

Small intestine, descending col


on

Appendix, small intestine, bladd


er

Left Inguinal (iliac)

Small intestine, descending col


on, sigmoid colon

Abdominal Quadrants

Vertical midline
Horizontal umbili
cus
Right and left upper
and lower quadrants
Used clinically

Peritoneum

Serous membrane of the abdo


minal cavity

Visceral peritoneum covers surf


ace of abdominal organs
Parietal peritoneum covers abdo
minal wall
Peritoneal cavity lies between th
ese layers and contains serous fl
uid

PERITONEUM

Peritoneum parietale peritoneum viscerale


(REFLEXI PERITONEUM) : folded thing (plic
a), the hanger of viscera or Omentum

Function

Secretes a lubricating serous fluid


that continuously moistens the
associated organs
Absorb
Support viscera

REFLEXI PERITONEUM
FOLDED

LAYER
HANGER

Plica rectouterina
Plica umbilicalis
lateralis
Omentum majus
Omentum minus
Mesenterium
Mesocolon transversum
Lig.hepatogastricum
Lig.falciforme hepatis

CAVUM PERITONEI
The content is sereus fluid, closed (on male),
but on the female theres relation with the out
er side OSTIUM TUBAE UTERINAE
Cavum peritonei s.s.(=greater sac)
BURSA OMENTALIS (=lesser sac)
FORAMEN EPIPLOICUM WINSLOWI

Peritoneal vs. Retroperitoneal

Peritoneal

Surrounded by perito
neal cavity
Liver, stomach, ileum
jejunum, transverse
and sigmoid colon

Retroperitoneal

Lie behind peritoneu


m
Ascending and desc
ending colon, pancre
as, rectum, duodenu
m,

The relationship between viscera and peritoneum

Intraperitoneal viscera viscera completely surrounded by peritoneum, e


xample, stomach, superior part of duodenum, jejunum, ileum, cecum, verm
iform appendix, transverse and sigmoid colons, spleen and ovary
Interperitoneal viscera most part of viscera surrounded by peritoneum,
example, liver, gallbladder, ascending and descending colon, upper part of r
ectum, urinary bladder and uterus
Retroperitoneal viscera some organs lie on the posterior abdominal wal
l and are covered by peritoneum on their anterior surfaces only, example, ki
dney, suprarenal gland, pancreas, descending and horizontal parts of duode
num, middle and lower parts of rectum, and ureter
Intraperitoneal viscera
Interperitoneal viscera

Retroperitoneal viscera

Structures which are formed by periton


eum
Omentum two-layered fold of p
eritoneum that extends from sto
mach to adjacent organs

Lessor omentum
Greater omentum

Mesenteries or mesocolons
two-layered fold of perito
neum that attach part of the
intestines to the posterior a
bdominal wall

Mesentery suspends t

he small intestine from th


e posterior abdominal wal
l
Broad and a fan-shaped
Consists of two peritoneal
layers
Radix of mesentery
15 cm long
Directed obliquely from
left side of L2 to in front
of right sacroiliac joint

Mesoappendix

Triangular mesentery e
xtends from terminal part
of ileum to appendix
Appendicular artery runs i
n free margin of the meso
appendix

Transverse mesocolon
a double fold of peritoneu
m which connects the transv
erse colon to the posterior ab
dominal wall

Sigmoid mesocolon
inverted V-shaped, with ap
ex located in front of left uret
er and division of common ili
ac artery

Ligaments

two-layered f
olds of peritoneum that attache
d the lesser mobile solid visera
to the abdominal wall

Ligaments of liver

Falciform ligament of liver

Consists of double peritoneal l


ayer
Extends from anterior abdomin
al wall (umbilicus) to live
Free border of ligament site of l
igamentum teres

Vasa Abdominis

Abdominal aorta

Continuation of thoraci
c aorta at aortic hiatus
of diaphragm in front o
f T12
Terminates at lower b
order of L4 vertebra b
y dividing into right an
d left common iliac art
eries

Parietal branches

Inferior phrenic a. (one pair)


Lumbar a. (four pairs of arteri
es that supply the posterior ab
dominal wall)
Median sacral a.

Visceral branches
Paired branches

Middle suprarenal artery


Renal artery
Testicular (ovarian) artery

AORTA ABDOMINALIS
A. COELIACA
A. MESENTERICA SUPERIOR
A. MESENTERICA INFERIOR

V. CAVA INFERIOR
V. PORTA
V. MESENTERICA SUPERIOR
V. MESENTERICA INFERIOR

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Unpaired branches

Celiac trunk a short t


hick vessel that arises fro
m the front of aorta, at th
e level of T12
Superior mesenteric a.
arises from the front of
aorta, at the level of L2
Inferior mesenteric a.
arises from the front of
aorta, at level of L3

Celiac trunk
Left gastric a.

Left branch
Right branch
Cystic a.
Right gastric a.

Common
hepatic
a.

Short gastric a.
Splenic a.

Proper hepatic a.
Gastroduodenal a.
Splemic branches

Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.

ARTERI COELIACA

A. GASTRICA SINISTRA
A. HEPATICA COMMUNIS
A. LIENALIS
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A. Mesenterica superior
Superior
Mesenteric v.

Middle colic a.

Superior
mesenteric a.

Right colic a.
Ileocolic a.

A. ILEOCOLICA
A. COLICA
DEXTRA

A. Mesenterica inferior

Inferior mesenteric v.

Inferior mesenteric a.
Left colic a.
Sigmoid a.

Superior rectal
/ hemorrhoidalis a.

A. COLICA SINISTRA
AA. SIGMOIDEAE
A. RECTALIS (hemorrhoidalis)

Vascularisasi The Large Intes


tine

Figure 24.23a

Blood Supply of Liver

Hepatic Artery

Hepatic Vein

from abdominal aorta


to inferior vena cava

Hepatic Portal Vein

Carries nutrient-rich blood f


rom stomach and intestines
to liver
Portal system = 2 capillary
beds, first in small intestine,
second in liver, then empty i
nto hepatic vein

Blood Supply of Liver

Figure 21-19: The hepatic portal system

Hepatic
portal vein

Hepatic portal vein


General features
Formed behind the neck of pa
ncreas by the union of superior
mesenteric vein and splenic ve
in
Ascends upwards and to the ri
ght, posterior to the first part of
duodenum and then enters the
lesser omentum to the porta h
epatis, where it divides into rig
ht and left branches
There are no functioning valve
s in hepatic portal system
Drains blood from gastrointesti
nal tract from the lower end of
oesophagus to the upper end
of anal canal, pancreas, gall bl
adder, bile ducts and spleen

ANASTOMOSE PORTO CAVALIS

42

Portal-systemic anastomoses
1. At the lower end of the oesophagus
Hepatic portal vein left gastric vein esophageal
venous plexus esophageal vein azygos vein
superiorvena cava

2. At rectal venous plexus


Hepatic portal vein splenic vein inferior mesenteric
vein superior rectal vein rectal venous plexus
inferior rectal and anal veins internal iliac vein
inferior vena cava

3. At periumbilical venous plexus


Hepatic portal veinparaumbilical veinperiumbilical
venous plexus

thoracoepigastric and superior epigastric vein superiorv


ena cava
superficial epigastric and inferior epigastric veins inferior
vena cava

4. Portal-retroperitoneal anastomosis
Between the retroperitoneal branches of the
colic veins and the lumbar veins, pancreati
coduodenal veins with the renal veins and t
he subcapsular veins of the liver with the p
hrenic veins twigs of colic veins (portal) an
astomosing with systemic retroperitoneal v
eins

Vena coronaria ventriculi


vena oesophagei
(VARICES
OESOPHAGEI)
Vena hemorrhoidalis
superior- vena
hemorrhoidalis mediavena hemorrhoidalis
inferior (HEMORRHOID)
Vena par umbilicalis-vena
thoraco epigastrica vena
epigastrica superficialis
(CAPUT MEDUSSAE)
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Extrahepatic Biliary Apparatus


Consists of
Gallbladder
Left and right hepatic d
ucts
Common hepatic duct
Common bile

Gallbladder
Position :lies in fossa for gallbladder
on visceral surface of liver
Four parts
Fundus of gallbladder
Surface projection: at the junction
of right midclavicular line and right
costal arch
Body of gallbladder
Neck of gallbladder
Cystic duct
Function: stores and concentrate
bile

Biliary duct system

Right and left hepatic


ducts unite outside of li
ver to form the commo
n hepatic duct
Cystic duct joins comm
on hepatic duct to form
common bile duct

Common bile duct and pancreatic du


ct run obliquely through the wall of th
e descending part of duodenum wher
e the two ducts usually unite to form t
he hepatopancreatic ampulla (amp
ulla of Vater), which rounded by sphi
ncter of hepatopancreatic ampulla
(sphincter of Oddi), each has an inde
pendent sphincteric mechanism for re
gulating flow, and opens at the major
duodenal papilla

Bile is secreted by the liver cells


Common hepatic duct

Biliary ductuli

Cystic duct

Right and left hepatic ducts

Gallbladder (store, concentrate)

when the fat enters the small intestine,


the gallbladder contracts, the sphincter
of hepatopancreatic ampulla relax

Common bile duct


Major duodenal papilla

CANALIS ANALIS

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Inguinal region
Boundaries
Inguinal ligament
Lateral margin of rec
tus abdominis
A horizontal line stre
tching from anterior i
liac spine to laeral m
argin of rectus abdo
minis

Inguinal canal
Position: oblique passage, 4cm long, located 1.5cm ab
ove medial half of inguinal lig.

Boundaries
Anterior wall

Aponeurosis of obliquus externus abdominis


Obliquus internus abdominis (lateral third of
wall)

Post wall

Transverse fascia

Roof arched lower fibers


of obliquus internus and tra
nsversua abdominis
Floor inguinal ligament

Two openings

A. Superficial inguinal ring


B. Deep inguinal ring defect in t
ransverse fascia 1.5cm above mi
dpoint of inguinal ligament

A
A

Descent of testes

Seven-week embryo showing the


testis before its descent from the
dorsal abdominal wall

Fetus at 28 week the testis passing


through the inguinal canal

Newborn

Structures passing through the inguinal canal

Spermatic cord and ilioinguinal nerve in males

Round ligament of uterus and ilioinguinal nerve in females

Indirect inguinal heinia and direcet inguinal


heinia

INNERVASI VISCERA ABDO


MINIS

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Nervers of abdomen

N.THORACO ABDOMINALIS
N. PHRENICUS
N. VAGUS
Nn. SPLANCHNICI
TRUNCUS SYMPATHICUS
PLEXUS OTONOM
PLEXUS LUMBALIS

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Nervers of abdomen

N. intercostalis T7 T12
N. Lumbalis L1dan L2 (plexus lu
mbalis) :

Iliohypogastric n.

Ilioinguinal n.

Arises from lubar plexus


Passes forward in the interval between obliquu
s internus and tranversus abdominis
Pieces obliquus internus abdominis 2.5 cm me
dial to anterior superior iliac spine
Pieces aponeurosis of obliquus externus abdo
minisabout 2.5 cm above superficial inguinal ri
ng
Runs parallel with iliohypogastric n. at a lower l
evel
Enters inguinal canal and emerges through su
perficial inguinal ring

Genitofemoral n.

Nervers of abdomen
Lumbar plexus
Formation: formed by a
nterior rami of L1-L3, a
part of anterior rami of
T12and L4
Position: lies within sub
stance of psoas major

Branches

Supplie
s lower part of anterior abdo
minal wall
Ilioinguinal n.
Passe
s through inguinal canal to s
upply skin of the groin and s
crotum
Lateral femoral cutaneous
Femoral n.
Obturator n.

Genitofemoral n.

Iliohypogastric n.

The End

VENA PORTAE

VENA MESENTERICA SUPERIOR


VENA LIENALIS
VENA MESENTERICA INFERIOR

VASA ABDOMINALIS
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ANASTOMOSE PORTOCAVALIS

V.CORONARIA VENTRICULI
V.HAEMORRHOIDALIS SUPERIOR
V.PARA UMBILICALIS
Haematemesis, haemorrhoid-melena, spider
navy
ASCITES

VASA ABDOMINALIS
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