Abdomen

ABDOMENNORZULAIKA BINTI ALIAS

PENGAJAR JURUPULIH PERUBATAN ANGGOTA

HAS 1033,ANATOMY II

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

ABDOMINAL CAVITY

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.

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

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.

Abdominal cavity

Abdominal cavityRetroperitoneal organs are located in retroperitoneal cavity.

Retroperitoneal organs

Abdomen regions

Abdominal regions

Abdomen regions

Abdominal regions

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

Abdominal quadrants

LUQRUQ

RLQ LLQ

Median plane

Transumbilical plane

Abdominal quadrants transumbilical plane:the umbilical (and the IV disc between L3 and

L4 vertebrae)

median plane:longitudinally throught the body

Abdominal quadrants

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.

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

Rectus abdominis

Rectus abdominis

Rectus abdominis


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


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

Internal oblique

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

External oblique

External oblique

Inguinal ligament

Rectus sheath(ant.layer)

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.



umbilical

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.

Muscles of the posterior abdominal wall

Posterior view

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

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

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

Quadratus lumborum

Nerves of the anterolateral abdominal wall



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)



Contents of abdominal cavity



Digestive organs

-stomach,small intestine,large intestine, liver, pancreas, gallbladder

Spleen

Kidney

Adrenal(suprarenal gland)

Intraperitoneal organs

Intraperitoneal organs are completely covered by visceral peritoneum

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.

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.

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

Retroperitoneal organs

Organs outside the peritoneal cavity.

Partially covered with peritoneum

Kidneys, pancreas, duodenum, ascending and descending colon and rectum.

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.

Kidney

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

Pancreas

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.

Large intestine

ascending and descending colon and rectum.

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.

Common abdominal problems Abdominal hernia(rupture)

-occur at the anterolateral abdominal wall.

-mostly occur in the inguinal,umbilical and epigastric region.

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.

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.

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.

Epigastric hernia

Occurs in the midline between the xiphoid process and the umbilicus

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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Health & Medicine

Abdomen