Surface Anatomy of the abdominal viscera and abdominal regions.

HB II Seminar

1. Surface Anatomy of the abdominal viscera and abdominal regions.

2. OBJECTIVES Abdomen surface anatomy. Defining the surface projection of the abdomen. How to find the Superficial inguinal ring. How to determine lumbar vertebral levels. Visualizing structures at the L1 vertebral level. Visualizing the position of major blood vessels. Using abdominal quadrants to locate major viscera. Where to find the kidneys & spleen. Defining surface regions to which pain from gut is referred.

3. Landmarks Imaginary planes and lines Regions and areas Kidneys & Spleen

4. Lumbar vertebral levels Superficial inguinal ring Quadrants Major blood vessels

5. Abdomen Surface Anatomy. Sulaiman Abuhaimad

6. Abdominal Boundaries Superior Boundary Posterior Boundary Anterolateral Borders Inferior Borders

7. Xiphoid. Costal margin. 9 th costal cartilage Tendinous intersections. Umbilicus. Iliac Crest. Anterior superior iliac spine. Linea semilunaris . Linea Alba. Inguinal ligament. Pubic tubercle. Pubic crest. Pubic symphysis.

8. 2. Defining the surface projection of the abdomen. Moath Alkeaid

9. Palpable landmarks can determine the extant of the abdomen on the surface of the body These landmarks are: The costal margin The pubic tubercle Anterior superior iliac spine Iliac crest

10. 3. How to find the Superficial inguinal ring. Naif Alrajhi

11. Inguinal Canal It begins at the deep inguinal ring and ending at the superficial inguinal ring

12. Deep Inguinal Ring The deep (internal) inguinal ring is the beginning of the inguinal canal

13. Superficial Inguinal Ring The superficial (external) inguinal ring is the end of the inguinal canal

14. 4. How to determine lumbar vertebral levels. Abdulmalik Alawam

15. Lumbar Vertebrae 5 vertebrae between the rib cage and the pelvis Largest segments of the vertebral column Support the weight of the body and permit movement

16. Position First lumbar: Horizontally level with the transpyloric plane, on level with the 9 th costal cartilage Third lumbar: Horizontally level with the subcostal plane, on level with the 10 th costal cartilage The umbilicus is found between the L2 and L3 vertebra

17. Position Fourth lumbar: Horizontally level with the supracristal plane on level with the Iliac crest Fifth lumbar: Horizontally level with the intertubercular plane on level with the tubercle of the crest of ilium

18. 5. Visualizing structures at the L1 vertebral level. Fawaz Al Afandi

19. Determining the L1 vertebral level. Medial end of the 9 th CC & body of L1 / transpyloric plane. Midway between suprasternal –jugular- notch & pubic symphysis .

20. Structures at the L1 level Beginning & upper limit of the Duodenum. Hill of the Kidneys. Neck of Pancreas. Origin of Sup. Mesentric artery. Right & left colic flexures also are close to this level.

21. Major blood vessels relation. Celiac trunk at the upper border. Sup. Mesenteric artery at the lower border.

22. 6 . Visualizing the position of major blood vessels. Saleh Alorainy

23. Each of the vertebral levels in the abdomen is related to the origin of major blood vessels

24. LI Vertebra The celiac trunk originates from the aorta at the upper border of the LI vertebra. • The superior mesenteric artery originates at the lower border of the LI vertebra.

25. LII Vertebra The renal arteries originate at approximately the LII vertebra .

26. LIII Vertebra The inferior mesenteric artery originates at the LIII vertebra .

27. LIV Vertebra The aorta bifurcates into the right and left common iliac arteries at the level of the LIV vertebra.

28. LV Vertebra The left and right common iliac veins join to form the inferior vena cava at the LV vertebral level.

29. What is the purpose ? Vascular surgery

30. 7. Using abdominal quadrants to locate major viscera. Tariq Dabi l

31. Importance : Used to help : Anatomists, Doctors, Medical students

32. Location Of Major Viscera by using Quadrants of the Abdomen: RUQ: Liver Gallbladder LUQ: Spleen Stomach RLQ: The Cecum Appendix LLQ: The Descending Colon Sigmoid Colon

33. Using Abdominal Quadrants To Locate Major Viscera:

34. 8 . Where to find the kidneys & spleen . Abdullah Alrudayni

35. Kidneys

36. Where to find kidneys The kidneys project onto the back on either side of the midline and are related to the lower ribs

37. Where to find kidneys The left kidney is a little higher than the right and reaches as high as rib XI The superior pole of the right kidney reaches only as high as rib XII

38. Where to find kidneys The lower poles of the kidneys occur around the level of the disc between the LIII and LIV vertebrae

39. Spleen

40. Where to find spleen The spleen projects onto the left side and back in the area of ribs IX to XI

41. Where to find spleen The spleen follows the contour of rib X and extends from the superior pole of the left kidney to just posterior to the mid axillary line

42. 9. Defining surface regions to which pain from gut is referred. Fahad Alhussainan

43. THE ABDOMINAL REGION The Regions are formed by : Two Horizontal Planes Midclavicular Planes Two Vertical Planes Subcostal Intertubercular Central regions Epigastric, Umbilical, Hypogastric/Pubic Regions on each side Hypochondrium, Lumbar/Flank, Iliac/Groin

44. Defining surface regions to which pain from the gut is referred

45. Referred Pain? Three distinct forms of pain exist: Somatic Visceral Referred pain

46. Referred Pain

47. Referred Pain

48. References Gray’s Anatomy for students 3 rd edition NETTER , MD ATLAS OF HUMAN ANATOMY 6 TH EDITION

49. QUESTIONS ?

50. This Seminar was done by: Sulaiman Abuhaimad Moath Alkeaid Naif Alrajhi Abdulmalik Alawam Fawaz Al A fandi Saleh Alorainy Tariq Dabil Abdullah Alrudayni Fahad Alhussainan

51. Thank you!