Transcript Abdomen - 山东大学医学院人体解剖学教研室

Abdominal wall
山东大学医学院 解剖教研室
李振华
Anterior wall
Layers ( from superficial to
deep)
 Skin
 Superficial fascia
 Anterolateral muscles
 Transversalis fascia
横筋膜
 Extraperitoneal fascia
腹膜下筋膜
 Parietal peritoneum
壁腹膜
腹
Superficial fascia－
divisions below
umbilicus
 Superficial fatty layer
(Camper’s)
 Membranous layer
(Scarpa’s)
Muscles of abdomen
Anterolateral group

Obliquus externus
absominis 腹外斜肌

Oblequus enternus
abdominis腹内斜肌

Transversus
abdominis腹横肌

Rectus abdominis 腹
直肌
Posterior group
 Quadiatus lumborum 腰
方肌

Psoas major 腰大肌
Obliquus externus absominis
General direction of fibers:
downward, forward and
medially (run down and
inward)
Structures

Inguinal ligament
腹股沟韧带

Lacunar ligament
腔隙韧带

Superficial inguinal ring
腹股沟浅环 －triangularshaped defect in
aponeurosis of obliquus
externus abdominis above
pubic tubercle
腹外斜肌
Obliquus internus abdominis


Deep to obliquus
externus abdominis
General direction of
fibres: upwards,
forwards and medially
腹内斜肌
Transversels abdominis 腹横肌

Deep to obliquus
internus


Inguinal falx 腹股沟镰:
arch over spermatic
cord, inserted with
transverses abdominis
fiber into medial part of
pecten of pubis
Cremaster 提睾肌:
around the spermatic
cord and testis
Rectus abdominis 腹直肌





Position: lie on to either of
midline
Origin: pubic crest and
symphysis
Insertion: xiphoid and 5th-7th
costal cartilages
Has 3-4 tendinous
intersections 腱划
linea semiluaris 半月线
Similar functions for above four pairs of muscles




Support and compress the abdominal viscera
Increase intra-abdominal pressure, aid in expulsive
efforts-vomiting, coughing, sneezing, defecation,
urination and childbirth.
Depress ribs, assist in (the act of force(4)expiration.
Flex, lateral flex, and rotate vertebral column
Sheath of rectus abdominis 腹直肌鞘
Ant layer－formed by fusion of
aponeurosis of obliquus externus
abdominis and anterior leaf of
aponeurosis of obliquus internus
abdominis
Post layer

Formed by fusion of posterion leaf
of aponeurosis of obliquus
internus abdominis and
aponeurosis of transverses
abdominis

Absent in about 4-5cm below the
umbilicus, where aponeuroses of
all three muscles form anterior
layer the lower free border named
arcuate line

Below this line rectus abdominis in
contact with transverse fascia
Linea alba 白线
－tendinous raphe between right and left recti from xiphoid to pubic symphysis.
Inguinal region 腹股沟区
Boundaries
 Inguinal ligament
 Lateral margin of
rectus abdominis
 A horizontal line
stretching from
anterior iliac spine to
laeral margin of
rectus abdominis
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
Inguinal canal 腹股沟管
Position: oblique passage, 4cm long, located 1.5cm
above medial half of inguinal lig.
Boundaries

Ant wall


Aponeurosis of
obliquus externus
abdominis
Obliquus internus
abdominis (lateral
third of wall)

Post wall




Transverse fascia
Inguinal flax medially
Roof－arched lower
fibers of obliquus
internus and
transversua abdominis
Floor－inguinal lig．

Two openings

Superficial inguinal ring
腹股
沟浅环

Deep inguinal ring 腹股沟深环 －
defect in transverse fascia 1.5cm
above midpoint of inguinal
ligament

Structures passing through the inguinal canal


Spermatic cord 精索 and ilioinguinal nerve髂腹股沟神经 in males
Round ligament of uterus 子宫圆韧带and ilioinguinal nerve髂腹股
沟神经 in females
Inguinal Triangle (of Hesselbach) 腹股沟三角
Boundaries
 Inguinal ligament
inferiorly
 Lateral border of
rectus abdominis
medially
 Inferior epigastric
artery laterally
Indirect inguinal heinia and direcet inguinal heinia
Superficial vessels and cutaneous nerves

Arteries



Veins



Superficial epigastric a.
Superficial iliac circumflex a.
Thoracoepigastric v.
Superficial epigastric v.
Cutaneous nerves


Anterior and lateral
cutaneous n. of lower six
thoracic
Iliohypogastric n. (first lumb
nerves)
Deep vessels and nerves
Arteres
 Superior and inferior epigastric arteris
 Lower posterior intercostal a.
 Subcostal a.
 Four lumbar a.
Nerves

Iliohypogastric n. 髂腹下神经





Ilioinguinal n. 髂腹股沟神经



Arises from lubar plexus
Passes forward in the interval
between obliquus internus and
tranversus abdominis
Pieces obliquus internus
abdominis 2.5 cm medial to
anterior superior iliac spine
Pieces aponeurosis of obliquus
externus abdominisabout 2.5
cm above superficial inguinal
ring
Runs parallel with
iliohypogastric n. at a lower
level
Enters inguinal canal and
emerges through superficial
inguinal ring
Genitofemoral n. 生殖股神经
Layer ?
Subcostal incision
Muscle-splitting incision
Median or midline incision
Left paramedian incision
Transverse incision
Suprapubic incision
Abdomen 2
山东大学医学院 解剖教研室
李振华
Abdominal aorta 腹主动脉


Continuation of
thoracic aorta at aortic
hiatus of diaphragm in
front of T12
Terminates at lower
border of L4 vertebra
by dividing into right
and left common iliac
arteries
Parietal branches



Inferior phrenic a. 膈
下动脉(one pair)
Lumbar a. 腰动脉(four
pairs of arteries that
supply the posterior
abdominal wall)
Median sacral a. 骶
正中动脉
Visceral branches
Paired branches




Middle suprarenal
artery 肾上腺中动脉
Renal artery 肾动脉
Testicular (ovarian)
artery 睾丸（卵巢）动脉

Unpaired branches



Celiac trunk 腹腔干
－a short thick vessel that
arises from the front of
aorta, at the level of T12
Superior mesenteric a.
肠系膜上动脉－arises from
the front of aorta, at the
level of L2
Inferior mesenteric a. 肠
系膜下动脉 －arises from
the front of aorta, at level
of L3
Celiac trunk
Left gastric a.
Left branch
Right branch
Cystic a.
Short gastric a.
Common
hepatic a.
Splenic a.
Right gastric a.
Proper hepatic a.
Gastroduodenal a.
Splemic branches
Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
Celiac trunk
Middle colic a.
Inf. pancresticodudenal a.
Right colic a.
Ileocolic a.
Appendicular a.
Superior
Mesenteric v.
Superior
mesenteric a.
Jejunal and ileal a.
Inferior mesenteric v.
Inferior mesenteric a.
Left colic a.
Sigmoid a.
Superior rectal a.
Colic marginal artery
Relations of abdominal aorta
 Anteriorly (from above
downward)




Posteriorly


Upper four lumber
vertebrae
On its right


Pancreas
Ascending part of
duodenum
Radix of mesentery
Inferior vena cava
On its left

Left sympathetic trunk
Veins of abdomen and pelvis
Internal iliac vein 髂内静脉


Parietal tributaries: accompany with arteries
Visceral tributaries
→superior rectal vein→inferior mesenteric v.
①Rectal venous plexus
→inferior rectal vein→internal iliac v.
直肠静脉丛
→anal vein→internal pudendal v.
②Vesical venous plexus 膀胱静脉丛→vesical v.
③Uterine venous plexus 子宫静脉丛→uterine v.


External iliac vein
髂外静脉– accompany
the artery
Common iliac vein
髂总静脉– formed by
union of internal and
external iliac veins in
front of sacroiliac joint,
end upon L4~L5 by
uniting each other to
form inferior vena cava
Inferior vena cava 下腔静脉



Formed by union of two
common iliac veins anterior
to and just to the right of
L4~L5
Ascends on the right side of
aorta, pierces vena cava
foramen of diaphragm
opposite the T8 and drains
into the right atrium
Conveys blood from the
whole body below the
diaphragm to the right
atrium
Chief tributaries

Parietal

Paired inferior phrenic v. 膈
下静脉


paired lumbar v. 腰静脉 (four)
Visceral

Right and left renal veins 左、
右肾静脉



Right suprarenal vein
右肾上腺静脉 (left drain into
left renal vein)
Right testicular or ovarian v
右睾丸（卵巢）静脉. (left
drain into left renal vein)
Hepatic veins 肝静脉: right,
left and intermediate
Relations of inferior vena cava

Anteriorly (cranially to caudally)






Posteriorly





Right crus of diaphragm
Upper four lumber vertebrae
Left sympathetic trunk
Parietal branches of abdominal aorta
On its right




Liver
Head of pancreas
Horizontal part of duodenum
Right testicular (or ovarian) a.
Radix of mesentery
Psoas major
Right kidney
Right suprarenal gland
On its left

Abdominal aorta
Hepatic portal vein 肝门静脉
General features
 Formed behind the neck of
pancreas by the union of
superior mesenteric vein and
splenic vein
 Ascends upwards and to the
right, posterior to the first part
of duodenum and then enters
the lesser omentum to the
porta hepatis, where it divides
into right and left branches
 There are no functioning
valves in hepatic portal system
 Drains blood from
gastrointestinal tract from the
lower end of oesophagus to
the upper end of anal canal,
pancreas, gall bladder, bile
ducts and spleen
Variation and anomalies
of hepatic portal vein
Tributaries of hepatic
portal vein
1. Superior mesenteric v.
肠系膜上静脉
2. Inferior mesenteric v.
肠系膜下静脉
Splenic v. 脾静脉
Left gastric v. 胃左静脉
Right gastric v.胃右静脉
Cystic v. 胆囊静脉
3.
4.
5.
6.
7. Paraumbilical v.
附脐静脉
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 vein→paraumbilical vein→periumbilical
venous plexus→


thoracoepigastric and superior epigastric vein →
superiorvena 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, pancreaticoduodenal
veins with the renal veins and the subcapsular
veins of the liver with the phrenic veins twigs of
colic veins (portal) anastomosing with systemic
retroperitoneal veins
The lymphatic drainage of abdomen
Lymphatic drainage of
abdominal wall
 To axillary lymph node from
region above umbilicus
 To superficial inguinal lymph
node from region below
umbilicus
 To lumbar lymph node from
post wall of abdomen
Lymphatic drainage of
abdominal viscera
 Lumbar lymph nodes
腰淋巴结
 Lie on posterior abdominal
wall, along the abdominal
aorta and inferior vena cava
 Receive lymph from kidneys,
suprarenal glands, testes,
ovarirs, fundus of uterus,
ovary, and common iliac
nodes
 Right and left lumbar trunks
formed by efferent vessel
 Paired viscera－drain to the
lumbar lymph nodes

Celiac lymph nodes
腹腔淋巴结



－situated around the celiac
trunk
Superior mesenteric lymph
node 肠系膜上淋巴结
－situated around superior
mesenteric a.
Inferior mesenteric lymph
node 肠系膜下淋巴结
－situated around inferior
mesenteric a.
Intestinal trunk 腹腔干
－formed by efferent vessel of
celiac, superior and inferior
lymph nodes
Thoracic duct 胸导管






Begins in front of L1 as a dilated sac, the
cisterna chyli, which formed by joining of left
and right lumbar trunks and intestinal trunk
Enter thoracic cavity by passing through the
aortic hiatus of the diaphragm and ascends
along on the front of the vertebral column,
between thoracic aorta and azygos vein
Travels upward, veering to the left at the
level of T5
At the roof of the neck, it turns laterally and
arches forwards and descends to enter the
left venous angle
Just before termination, it receives the left
jugular, subclavian and bronchomediastinal
trunks
Drains lymph from lower limbs, pelvic cavity,
abdominal cavity, left side of thorax, and left
side of the head, neck and left upper limb
Spleen 脾
Location: lies in the left
hypochondriac region
(between stomach and
diaphragm) deep to the
9th to 11th rib, its long
axis corresponds
roughly to the 10th rib
Shape－reddish in colour
Two surfaces
 Diaphragmatic: smooth, convex
 Visceral: concave, hilum of spleen
Two extremities
 Anterior－wider
 Posterior－rounder
Two border
 Superior－has 2-3 splenic notch 脾切迹,
which serve as a landmark on palpation
when it is enlarge; normally it is not palpable
 Inferior－rounder
Functions: the spleen is considered to be
important in:
 Formation of lymphocytes and monocyte
 Phagocytosis of bacteria, inert particles and
white blood cells and platelets
 Destroying effete or abnormal red blood cells
 Making antibodies
Ralationships of spleen
 Diaphragmatic
surface－diaphragm

Visceral surface



Anteriorly－fundus of
stomach
Posteriorly－left suprarenal
gland and kidney
Inferiorly－tail of pancreas
and left colic flexure
Nervers of abdomen
Lumbar plexus 腰丛
 Formation: formed by
anterior rami of L1-L3,
a part of anterior rami
of T12and L4
 Position: lies within
substance of psoas
major
Branches

Iliohypogastric n. 髂腹下神经
Supplies lower part of
anterior abdominal wall

Ilioinguinal n. 髂腹股沟神经

Passes through inguinal
canal to supply skin of the
groin and scrotum
Lateral femoral cutaneous
股外侧皮神经

Femoral n. 股神经
Obturator n. 闭孔神经

Genitofemoral n. 生殖股神经

Lumbar sympathetic trunk 腰交感干



Made up of paired chains
with four to five lumbar
ganglia anterolateral to
vertebral column
Enters abdomen via the
diaphragm and as a
continuation of he thoracic
part
Passes inferiorly behind
common iliac vessels and
terminations by joining to
form unpaired ganglion
impar, anterior to sacrum
Abdomen 3
山东大学医学院 解剖教研室
李振华
Relationships of abdominal viscera



First layer－live, gallbladder, stomach
Second layer－duodenum, pancreas, spleen
Third layer－suprarenal gland, kidney, ureter,
inferior vena cava, abdominal aorta, nerves
and lymphatics
Relationships of the stomach

Anterior:




Live (right part)
Diaphragm (left upper part)
Anterior abdominal wall (left
lower part)
Posterior－separated by
peritonum of lesser sac from
the following (“stumach-bed”)





Pancreas
Left suprarenal gland
Left kidney
Spleen
Transverse colon and
transvers mesoclon
Arteries of stomach

Left and right gastric
arteries arise from
celiac trunk and
proper hepatic artery,
repectively. These two
vessels run in lesser
omentum along lesser
curvature , and
anastomose end-toend.



Right and left gastroepiploic
arteries arise from the
gastroduodenal and splenic
artery, repectively. These two
vessels pass into the greater
omentum, run parallel to the
greater curvature, and
anastomose end-to-end.
Short gastric arteries,
branches of splenic artery,
course through the
gastrosplenic ligament and
supply the fundus of stomach.
Posterior gastric artery (72%)
arise from the splenic artery,
course through the
gastrophrenic ligament and
supply the posterior wall of
fundus of stomach.
Venous drainage



Right and left gastric veins empty directly into hepatic portal vein.
Left gastroepiploic and short gastric veins drain into hepatic portal
vein via the splenic vein.
Right gastroepiploic vein join either superior mesenteric vein.
Lymphatics of stomach




Right and left gastric ln. lie
along the same vessels and
finally to the celiac ln.
Right and left gastroomental ln.
lie along the same vessels, the
former drain into subpyloric ln.,
the latter drain into splinic ln.
Supra- and subpyloric ln.
receive lymphatics from pyloric
part and finally to the celiac ln.
Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the celiac
ln.
Nerve supply
Parasympathetic innervation by
anterior (left) and posterior (right)
vagal trunks

The anterior trunk divides into
anterior gastric and hepatic
branches

The posterior trunk divides into
posterior gastric and celiac
branches

The anterior and posterior gastric
branches descend on the anterior
and posterior surfaces of the
stomach as a rule about 1 to 2 cm
from the lesser curvature and
parallel to it in the lesser omentum
as far as thr pyloric antrum to fan
out into branches called “crow’s foot”
to supply the pyloric part
Sympathetic innervation

Mainly from celiac ganglia

Affent and effent fibers derives from
thoracic segments (T5 －L1
The duodenum
Relationships of superior part
 Anteriorly



Posteriorly





Commom bile duct
Gastroduodenal a.
Hepatic portal v.
Inferior vena cava
Superioely


Quadrate lobe of live
Gallbladder
Omental foramen
Inferiorly

Head of pancreas
Relationships of
descending part
 Anteriorly




Posteriorly



Right renal hilum and ureter
Right renal vessels
Medially



Live
Transverse colon and
mesocolon
Loops of small intestine
Head of pancreas
Common bile duct and
pancreatic duct
Laterally

Right colic flexure
Relationships of horizontal
part
 Superiorly
 Head of pancreas
 Inferiorly


Anteriorly



Loops of small intestine
Radix of mesentery
Superior mesenteric a. and
v.
Posteriorly



Right ureter
Inferior vena cava
Abdominal aorta
Relationships of ascending part
 Right


Head of pancreas and abdominal aorta
Left

Left kidney and ureter
Relationships of liver

Diaphragmatic surface－
separated by diaphragm from
the following



Right costodiaphramatic
recess and lung
Cardiac base
Visceral surface


Left lobe is related to the
stomach and abdominal part
of esophagus
Right lobe is related to the
right colic flexure anteroly,
gallbladder and superior
duodenal flexure medially,
right kidney, superarenal gland
posteriorly
Blood supply
 Arteries



Superior
pancreaticoduodenal a.
Inferior
pancreaticoduodenal a.
Veins－follow arteries,
draining directly into
superior mesenteric and
hepatic portal veins
Divisions and relations of common bile duct
Supraduodenal segment
 Descends along the right
margin of hepatoduodenal lig.
 To the right of proper hepatic a.
 Anterior to hepatic portal v.
Retroduodenal segment
 Behind the superior part of
duodenum
 Anterior to the vena cava
 To the right of the hepatic
portal v.
Pancreatic segment
 Lies in a groove between
posterior surface of head of
pancreas and duodenum
Intraduodenal segment
 Enters the wall of
descending part of
duodenum obliquely where
jions the pancreatic duct to
form the hepatopancreatic
ampulla
 opens at the major
duodenal papilla
Divisions and relations of pancreas
Head of pancreas
 Located in C-shapes curvature
of doudenum
 Anteriorly


Transverse mesocolon
Posteriorly



Inferior vena cava
Right renal vessels
Common bile duct
Neck of pancreas
 Anteriorly－pylorus
 Posteriorly－commencement pf
hepatic portal v. (formed by union of
splenic and superior mesenteric
veins
Body of pancreas
 Anteriorly


Posteriorly






Separated from stomach by
omental bursa
Abdominal aorta
Left suprarenal gland
Left kidney
Left renal vessels
Spleen vein
Superiorly



Celiac trunk
Celiac plexus
Splenic a.
Tail of pancreeas


Runs in spleicorenal
ligament to reach hilum
of spleen
Accompanies with
splenic vessels
Relationships of spleen
Diaphragmatic surface
－diaphragm
Visceral surface



Anteriorly－fundus of
stomach
Posteriorly－left
suprarenal gland and
kidney
Inferiorly－tail of
pancreas and left colic
flexure
Celiac trunk
Left gastric a.
Left branch
Right branch
Cystic a.
Short gastric a.
Common
hepatic a.
Splenic a.
Right gastric a.
Proper hepatic a.
Gastroduodenal a.
Splemic branches
Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
Middle colic a.
Inf. pancresticodudenal a.
Right colic a.
Ileocolic a.
Appendicular a.
Superior
Mesenteric v.
Superior
mesenteric a.
Jejunal and ileal a.
Inferior mesenteric v.
Inferior mesenteric a.
Left colic a.
Sigmoid a.
Superior rectal a.