Transcript Anatomy Abdomen Forum 2012x

Abdomen Forum
2012
Surface Anatomy Guy:
Document where the following
organs/structures can be palpated:
1. Liver Rib5-10 right
2. Spleen under 9th,10th, 11th ribs. Begins about
1
midaxillary line. Posterior left
3.
2
3
4
Gallbladder 9th rib, midclavicular right
Draw in:
1. Linea alba
2. Linea semilunaris
3. McBurney’s point
4. ASIS
5. Deep Inguinal ring
6. Superficial Inguinal ring
Surface Anatomy Guy:
Draw in the 4 lines to create the “9region pattern”
Name the 9 regions.
1
2
What organs are found in each?
3
4
RH: R liver, kidney, Asc colon, GB?
E: liver, kidney (R/L), GB, stomach, pancreas,
Trans colon
LH: Stomach, spleen, kidney, tip of liver
RF: Asc colon, gutter,
U: SI, Colon
LF: Des colon, gutter, kidney
RG: Asc colon, ASIS, Ing Lig, appendix, cecum
P: appendix, cecum, SI, bladder, Genital organs,
femoral vessels
LG: des colon, ASIS, Ing Lig, sigmoid colon.
Patient A – 42 yearold male presenting
after trying to move
his dishwasher
Right: indirect inguinal hernia,
most common, congenital, more
in child and male. Lateral to
inferior epigastric vessels via
deep inguinal ring through entire
inguinal canal. Same covering as
spermatic cord. Enters the
scrotum
Compare and Contrast!
Left: direct inguinal hernia, older male
moving heavy things. Hernia out of
Hesselbach’s triangle (rectus abdominis,
inguinal ligament, inferior epigastric vessels)
through superficial inguinal ring. Medial to
inferior epigastric vessels. Cover by parietal
peritoneum & transversalis fascia with
external spermatic fascia
Patient B – newborn
male
What fascial layers are cut in this
procedure?
Lymphatic drainage of the wound site?
Vasetomy
Skin
Darto’s fascia
ESF
Cremaster
ISF
Superficial inguinal node
Identify!
1
What's my
lymphatic
drainage?
2
3
5
4
6
1. Liver (most-hepatic LN-celiac
LN; bare area-phrenic LNposterior mediastinal LN;
Falciform lig-parasternal LN;
round lig of liver-umbilicus &
anterior ab wall)
2. Spleen, splenic artery
3. L. kidney (Lumbar LN), renal
vein-IVC
4. Aorta
5. IVC
6. Ascending colon with
contrast (Sup Men LN),
cecum
Identify.
*
CT scan from a 27-year-old
male reveals the image to the
left.
Identify; What’s wrong?
58-year-old male with
abdominal pain. CT scans
reveal:
1
6
2
4
3
1: liver, cirrohsis
5
2: spleen, enlarged due to liver
cirohisis
3: bladder
4: Psoas major
65-year-old female presents with
the chief compliant of abdominal
swelling and discomfort of two
weeks duration. CT reveals:
Identify!
1.
2.
3.
4.
5.
6.
7.
8.
GB
Aorta
IVC
Gall stone
L. kidney
Liver
Spleen
R. Crus,
diaphragm
9. Portal vein
1
4
8
9
6
3
2
5
7
Identify!
5
6
4
3
2
1
1. Aorta; plexus abdominal
2. Erector spinae; extension
3. Right kidney;
embryological origin?
4. Duodenum, annular
pancreas
5. GB; proper hepatic, celiac
6. Liver; T6-T9,
Identify!
2
4
1
3
1. Pancreas; Celiac a.
and splenic a.
2. Trav Colon; Middel
colic a.?, SMA
3. Left renal vein.
4. SMA
5. Spleen; splenic vein
to Portal vein?
5
Identify!
1.
2.
3.
4.
5.
6.
7.
8.
8
6
4
2
5
7
1
3
Aorta
R. Kidney
L. Kidney
(Duodenum)
descending, celiac
artery and portal
vein, Celiac LN, T5T9, vagus
IVC
Liver
Psoas M
Transverse colon
Identify!
1.
2.
3.
4.
5.
6.
7.
8.
8
67
4
3
2 1
5
L. common iliac
R. common iliac
IVC
Ascending colon or
cecum
Psoas Major
External Oblique
Internal Oblique
Rectus abdominis
Imaging of a 75-year-old female with
abdominal pain, weight loss and
dysphagia reveals:
3
2
4
1
5
6
Barium enema in
a 1-year-old male
with difficulty
defecating
reveals:
1. Celiac trunk (left)
2. SMA
SUPER BONUS!
Identify!
Draw the celiac trunk, its major branches and anastomoses.
Draw the IMA, its major branches and anastomoses.
CT scan of a 50-year-old male
reveals:
Ascites!
1. Where is the fluid?
2. What layers must be
traversed to drain this
fluid? [Paracentesis]
1
1.
2.
3.
4.
Spleen
R. kidney
Fluid?
Arrow: liver or fluid?
Paracolic gutter left.
5. Paracentesis: Skin,
campers, scarpa’s, EO,
IO, TA, Tran fascia,
extraperinum fat,
pariental peritonum
3
2
Imaging from a 55-year-old female
with a history of breast cancer reveals
the images to the left.
1
4
Which breast?
How does this happen?
3
2
74-year-old female with rectal bleeding.
Metastasis:
• Lymphatic channels –
• Venous channels –
*
Radiograph from a 73-year-old female with abdominal pain and
elevated WBCs:
Hint:
1. Right diaphragm is
higher than the left.
Infection based on
high WBC. Infection
of liver or peritoneal
cavity pushing
diaphragm up?
Perforated bowel
(ulcer)causing air
leaked in between
diaphragm and
peritoneal cavity
(pneumoperitoneum)
CT scan from a 30-year-old
female with complaints of
vomiting and weight loss:
1
3
Stomach
Duodenum
Portal vein
SMA
Strangulation of distal
duodenum, SMA
syndrome. Duodenum
compressed by SMA or
abdominal aorta
4
2
1.
2.
3.
4.
1.
2.
3.
4.
5.
6.
7.
5
4
6
7
3
1
2
Celiac trunk
Splenic artery
Left gastric
Common hepatic
Hepatic proper
Gastroduodenal
pancreaticduodenal
superior (ant.)
1
1.
2.
3.
4.
3
4
2
SMA
Ileocolic artery
Right colic artery
Intestinal artery
1.
2.
3.
4.
4
1
3
2
SMV
IMV
Splenic vein
Portal vein
A 65-year-old
female presents
with her daughter
who indicates her
mother has a 2year history of
dementia, a recent
seizure and a long
history of
alcoholism [she
consumes only
Natty Light].
Physical exam
reveals the image
to the left:
Varicose vein from liver
damage. Paraumbilical vein
backed up from portal vein
blockage. Caput medusa.
1. Common hepatic duct
2. Cystic duct
3. Common bile duct
4. Main Pancreatic duct
5. Super bonus:
pars interarticularis
1
2
3
Super BONUS!
4
Draw the pattern of
sympathetic
innervation to the
________________.
Structure to be decided DURING the forum!
Include pre and
postganglionic
neurons and GVAs!
Referred Pain Guy:
A 30-year-old male presents with pain in
the region indicated.
1. What organ is indicated?
2. What spinal cord levels are involved?
3. Cell bodies in what location are
responsible for relay of pain from this
organ?
1
2
Green: Liver, GB and duodenum contact
with diaphragm (C3-5),
3
4
Yellow: Stomach, duodenum and head of
pancreas, Dorsal (posterior) root ganglia T5T9 (sympathetic)
Pink: Small intestine, appendix T10
dermatone; T9-T11 real; visceral pain,
would turn to somatic pain.
Referred Pain Guy:
A 16-year-old female presents with a fever
and pain in the region indicated.
1. Which organ is implicated?
2. What spinal cord level is involved?
3. Is this somatic or visceral pain?
1
2
3
4
1
2
Referred Pain Guy:
3
4
A 36-year-old female presents with pain in
the region indicated.
1. Which organ is implicated?