Clinical anatomy abdomin and details about this

The true abdominal cavity consists of the stomach, duodenum (first part), jejunum, ileum, liver, gallbladder, the tail of the pancreas, spleen, and the transverse colon. The posterior wall of the abdominal cavity is known as the retroperitoneum.

1. CLINICAL ANATOMY
ABDOMEN
Inst. ofAnatomy, 1st and2nd MedicalFaculty
3rd SurgicalClinic, 1st MedicalFaculty

2. Surgicalanatomy
Approachesto theperitoneal
cavity
ANTERIOR ABDOMINAL WALL

3. ABDOMINAL WALLS
•Superior –diaphragm
•Posterior –m. psoasmajor, m. quadratus
lumborum
•Inferior–pelvicfloor(m. levatorani, m.
coccygeus)
•Anterior andlateral–obliquemusclesandm.
rectusabdominis
•Internalsurfaceofmuscles–coveredby
transversalfascia andby peritoneum

4. Abdominalcavityv. peritonealcavity
•Abdominalcavity= peritonealcavity+
retroperitoneal(praeperitonealspace)

5. Projectionsof
organs
Points:
Murphy
Desjardins
McBurney
Lanz

6. ANTERIOR ABDOMINAL WALL
LINEA ALBA
•Cordofconnectivetissue
•Extend–sternum (xyphoidprocess) –
symphysis, pubicbones
•Aponeuroticpartsofobliquemuscles
attacheto thelinea alba atthemidline
•Oneofthesurgicalapproachesto the
peritonealcavity(midlineincision)

7. m. rectusabdominis, vagina mm. rectiabdominis
linea alba, m. obliquusabdominisext.

8. m. obliquusabdominisinternus
m. transversusabdominis, linea semilunaris

9. Structureofthevagina mm. rectiabdominis
Abovelinea semilunaris
Bellowlinea semilunaris

10. v. thoracicalateralis
v. thoracoepigastrica
vv. Paraumbilicales(lig. Teres hepatis)
v. epigastricasuperficialis
v. circumphlexailiumspfc.
Cavo-cavalanastomosis
Porto-cavalanastomosis
(caput medusae)
Superficialveinsofthe
thoracicandabdominalwall

11. aa. intercostales
a. epigastricasup.
a. epigastricainf.

12. Somatosensoryinnervation:
Intercostalnerves
n. iliohypogastricus
n. Ilioinguinalis
Somaticpain: from
abdominalwallandparietal
peritoneum, sharpandwell
localized
Visceralpain: fromviscera,
autonomicnerve fibers,
distension, muscular
contraction, vague,
nauseating, poorlylocalized,
tendsto bereferred
Sensoryinnervationof
theanterior abdominal
andthoracicwall(skin
andperitoneal
innervation)

13. Referredpain
•Visceraldisease-frequentlyaccompaniedby pain
whichisreferredto partsofbody surface
•In thiscutaneousarea skin ishyperesthetic, exhibits
vasomotorchangesandcontractionsofmuscles
(defénsemusculaire, restingposition)
•Thiscutenaouszonesare termedHeadzones–
roughlycoincideswiththesegmentalinnervationof
theskin

14. HEAD ZONES

15. Tworeasons
(indications) for
openingof
abdominalcavity
Diagnosis
Treatment

16. Noninvasiveexamination:
Ultrasoundexamination-sonography
RTG –computertomography(CT)
Nuclearmagneticresonance (MRI)
PET/CT(applicationofisotops)
Invasiveexamination(endoscopy)
upperendoscopy, coloscopy, enteroscopy,
enteralcamera
Endosonography-combinationsonoandendoscopy
Exploratorylaparotomy

17. Diagnosticprocedures-
invasive:sono-puncture,
CT -puncture
Endosonography-puncture

18. Approachesto theperitonealcavity:
•Laparoscopicapproaches
•Laparotomicapproaches(open)
•Surgeonpreference isthedeterminant of
whichoperationisperformed

19. Laparoscopy
puncture–Veressineedle
kapnoperitoneum-CO
2
Elevationoftheabdominalwall
(neverair–dangerofairembolism)
Complications:
Injuryofepigastricvessels
Punctureofintestine

22. Whylaparoscopy?
Short-termedreasons–shorterhospitalstay,
shortercovalescence, decreased
postoperativenarcoticuse, earlyrestoration
ofperistalticmovements, betterresultsof
pulmonaryfunctiontests
Long-termedreasons-
Lesserfrequencyofabdominalhernias

23. Middlelaparotomy
Pararectalincision

24. PARARECTAL INCISION

25. Transrectal
incision

26. A transverserightlowerquadrantincision
Appendectomy

27. Subcostalincision

28. Pfannenstiel´s incision

30. Mercedes-BenzStern incision

31. 2. Inguinalcanal,
inguinalhernia
DirectX indirect
Anterior abdominalwall

32. Canalis inguinalis
Aponeurosism. obliquiabdominisexterni
Superficial
inguinalring
Spermatic
cord
Round
uterine
ligament

33. M. Obliquusabdominis
internus

35. M. Transversusabdominis

36. Interfoveolarlig.
Falx
ingui
nalis
Posterior aspect
Deep
inguinalring
Inguinal
triangle
Attenuated
areas:

38. Fourwallsoftheinguinalcanal
•Lower–inguinalligament
•Anterior–aponeurosisofthem. obliquus
abdominisexternus
•Superior–obliquemucles
•Posterior–transversalfascia +
peritoneum

39. Plicaumbilicalis
mediana(urachus),
medialis(a.umbilicalis),
lateralis(vasa
epigastricainf.)
Foveasupravesicalis
Foveainguinalis
medialis
(trigonuminguinale)
Foveainguinalis
lateralis
(anulusing. prof.)

40. Hernia supravesicalis–
foveasupravesicalis
Hernia inguinalisdirecta–
trigonuminguinale–anulusing. spfc.
Hernia inguinalisindirecta–
anulusing. prof. –anulusing. spfc.
event. Hernia scrotalis
Hernia femoralis–septum femoralein
lacunavasorum-fossa iliopectinea–
hiatussaphenus

42. Openherniotomywith
plastic(polypropylene)
mesh
Inguinalherniarepair–implantationof
alloplasticmaterial

44. Laparoscopicview
trigonuming. –
directhernia
deeping. ring –
indirecthernia

46. 3. Supramesocolicpart ofthe
peritonealcavity

47. OMENTAL BURSA (lessersac) –WALLS

49. OMENTAL BURSA

50. BILIARY DUCTS

51. Extrahep.
Biliaryducts

52. PapillaVateri

53. variability ofextrahepaticbiliarytreeanditsbloodsupply

54. variability ofcholedochalandpancretaicductopening
variability ofpancrateicducts

57. PANCREAS -Relations

60. 4. Appendixvermiformisand
appendicitis

61. Lanz´s point
Bispinallinea
McBurney´s point
Monrolinea

63. Positio:
●praecaecal
●laterocaecal
●ileocaecal
●retrocaecal
●subcaecal
●pelvic

64. Lig. appendico-ovaricum

65. THE ACUTE ABDOMEN :
Clinicalsyndrome, characterizedby thesudden
onsetofintense abdominalpainandassociated
signs(shock, vomiting, changesin gastrointestinal
peristalticactivity,fever)
Onsetisspontaneousorfollowstrauma

66. Non–traumaticacuteabdomen:
causes
•Inflamatorychanges(gastritis,
gastroenteritis, pancreatitis, appendicitis)
•Ileus (intestinalblockage)–mechanical
(adhesions, tumor, vascular)
•GIT haemorrhage

67. Appendicitis
•Patientshistory
•Clinicalexamination(abdominal
evaluation)
•Laboratorytests(bloodtests)
•Rtg, Ultrasound, CT

68. Positioretrocaecalis

69. Positioileocaecalis

70. Positioretrocaecalis

71. Positioretrocaecalis

72. Advancedappendicitis
enlarged, edematous

73. Advancedappendicitis

74. Advancedappendicitis

75. Rightlowerincision(SprengelandMcBurney)

77. RESECTION OF THE
APPENDIX

78. Laparoscopicappendectomy

79. Laparoscopicappendectomy

80. Pyletrombosis
Thrombosisofthe
portalvein

81. Posttraumaticacute
abdomen
1. Hemoperitoneum
2. Perforation
oftheGIT
3. Combination
ofboth

82. Intrahepaticbleeding

83. Splenicruptureandbleeding

84. Hepaticrupture

85. Perforationoftheduodenum,
Airin theretroperitonealspace

86. Vasculardiseases

87. Female64 y, strongsmoker40 cigarettesdaily,
Stenosesofintestinalarteries

88. Stenosisandscleroticchanges
ofthecoeliactrunk andits
branches

89. Retroperitoneal
space
Primarly
Kidney
Suprarenalgland
Vesselsand
nerves
Lymphnodes
Secondarily
Duodenum
Pancreas