Download Anterior abdominal wall

Thoracic wall 
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Vertebra
Ribs – typical, 1st rib
Clavicle
Sternum
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Skin
o Superficial fascia
o Platysma muscle
o Mammary gland
 Nipple (ICS 4)
 Areola
 Areolar glands
 Mammary lobule
 Lactiferous ducts
 Suspensory ligaments (Cooper’s)
o Anterior cutaneous branches of intercostals nerves
o Retrommamary space
o Lateral cutaneous branches (anterior & posterior)
Deep fascia
Pectoralis major
o Deltopectoral triangle
 Cephalic vein
o Lateral pectoral n.
o Pectoral branch of thoracoacromial artery
o Medial pectoral n.
Clavipectoral fascia
o Subclavius muscle
o Pectoralis minor
o Cephalic vein drains into axillary vein
Subclavian & axillary vessels
Anterior Serratus
o Lateral thoratic a.
o Long thoratic n.
Intercostal space (ICS4)
o External intercostals membrane, muscle
o Internal intercostals muscle
o VAN
Internal thoracic vessels (ICS2)
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Pleural cavity:
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Transverse muscle
Innermost muscle
Endothoracic fascia
Phrenic nerve
Vagys nerve
Root of the lung
Pleura: Parietal
Visceral
 Pleural subdivisions: Costal, diaphragmatic, mediastinal, cupula (cervical
pleura)
 Pleural recesses: Costodiaphragmatic, costomediastinal
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Descending aorta
Azygos vein
SVC
Sympathetic trunk
Greater splanchnic nerve
Intercostal vessels (VAN)
The lung:
 Apex
 Fissures: Oblique, Horizontal
 The lobes of the right lung: superior, middle, inferior
 The lobes of the left lung: superior, inferior, lingulae
 The lung surfaces: Costal, medial, diaphragmatic
 The lung contact impressions: (The right) – Cardiac, esophagus, azygos,
Brachiocephalic vein
(The left) – Cardiac, Aortic arch and
Descending aorta, 1st rib,
Brachiocephalic vein
Hilus: Pulmonary arteries, pulmonary veins, bronchi, lymph nodes
Mediastinum
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Superior mediastinum – trachea and tracheal bifurcation, esophagus,
superior border of fibrous pericardium, ascending aorta, superior vena cava,
brachiocephalic veins, brachiocephalic trunk (right), subclavian artery and
common carotid artery (left), thymus gland.
 Anterior mediastinum – between sternum and pericardium, contains
thymus gland.
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Middle mediastinum –
1) Pericardium - fibrous pericardium, serous pericardium (visceral &
parietal), pericardial cavity, oblique & transverse sinuses.
2) The heard – Coronary atrioventricular groove, anterior & posterior
interventricular grooves.
The coronary arteries: left coronary artery (left anterior
descending (LAD) & circumflex branches), right coronary
artery (posterior interventricular, marginal & anterior right
atrial branches).
The coronary veins: coronary sinus, great cardiac vein,
middle cardiac vein, small cardiac vein.
The right atrium – pectinate muscles, crista terminalis,
fossa ovalis, superior & inferior vena cava, coronary sinus,
anterior cardiac veins, atrioventricular orifice.
The left atrium – pectinate muscles, crista terminalis, fossa
ovalis, pulmonary veins, mitral orifice.
The right ventricle – tricuspid valve (anterior, posterior
and septal cusps), papillary muscles, chordae tendinae,
septomarginal trabecula (moderator band), trabecula
carneae, conus arteriosus, the valves of pulmonary trunk
(left, right and anterior).
The left ventricle – mitral valve (anterior and posterior
cusps), papillary muscles, chordae tendinae, aortic valves
(left, right and posterior), muscular and membranous parts
of interventricular septum.
Posterior mediastinum – esophagus, aortic arch, ligamentum
arteriosum, descending aorta, vagus nerve (left & right), left recurrent
laryngeal nerve, azygos vein, hemiazygos vein, accessory hemiazygos vein,
thoracic duct, greater splanchnic nerves.
Anterior abdominal wall
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Abdominal wall boundaries – Xifisterial junction; Costal margin
(7-10); pubic symphysis, pubic crest; pubic tubercle; inguinal ligament;
anterior superior iliac spine (ASIS); iliac crest, tubercle of the iliac crest.
Fascial arrangements:
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Camper’s fascia
Scarpa’s fascia – superficial epigastric veins, superficial circumflex iliac
vessels, cutaneous nerves (T7-L1).
Muscles of Anterior Abdominal Wall and Inguinal Region:
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External oblique muscle – aponeurosis of ext.obl.muscle, superficial
inguinal ring (superficial arch), lateral & medial crura, intercrural fibers,
inguinal ligament, ilioinguinal nerve, spermatic cord/round ligament.
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Internal oblique muscle – aponeurosis of int.obl.muscle, second arch
of arcade, conjoint tendon.
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Transversus abdominis muscle – aponeurosis of
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transv.abd.muscle, deepest arch of arcade, conjoint tendon.
Transversalis fascia – deep inguinal ring, inferior epigastric vessels.
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Rectus abdominis muscle – rectus sheath, linea alba, tendinous
insertions, subcostal nerves (T7-T12), inferior and superior epigastric vessels,
arcuate line, semilunar line.
The Abdominal Wall: Falciform ligament, ligamentum teres, median
umbilical ligaments (urachus & obliterated umbilical arteries), extraperitoneal
fascia (areolar tissue) & peritoneum.
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Peritoneum and Peritoneal Cavity
 Peritoneum –
Parietal peritoneum & peritoneal cavity (greater sac).
Visceral peritoneum.
Greater omentum
Lesser omentum (Hepatoduadenal & Hepatogastric
ligaments).
Epiploic foramen; Omental bursa (lesser sac) & its
superior, inferior and splenic recesses.
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Diaphragm
Liver – diaphragmatic & visceral surfaces; falciform ligament; round
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ligament; right, left, quadrate and caudate lobes;
gallbladder; porta hepatis; subphrenic recesses; bare area;
coronary ligament; left & right triangular ligament;
hepatorenal ligament (right) & hepatorenal recess.
Stomach – greater & lesser curvature.
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Duodenum – pyloric part (ampula), duodenojejunal junction, ligament of
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Traitz (will be seen in the next diss.).
Spleen – splenorenal ligament, gastrosplenic ligament
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Small intestine – Jejunum & Ileum
Large intestine – cecum & vermiform appendix, ascending colon, right
colic flexure, transverse colon, left colic flexure, phrenicocolic ligament,
descending colon, sigmoid colon, tenia coli, haustra, appendices epiploicae.
 The vessels –
Porta hepatis: common bile duct, portal vein, hepatic artery
proper.
Celiac trunk: :
1) Left gastric artery
2) Common hepatic: a) hepatic proper: right gastric artery
b) Gastroduadenal: right gastroepiploic &
superior panceratoduadenal arteries.
3) Splenic artery: left gastroepiploic artery.
Superior mesenteric artery:
1) Middle colic artery.
2) Right colic artery.
3) Ileocolic artery: ileal & cecal branches.
* intestinal arteries, arcades, vasa recta.
Inferior mesenteric artery:
1) Left colic artery.
2) Sigmoid arteries.
3) Superior rectal artery.
Portal vein and its tributaries: Splenic vein, superior
mesenteric vein, inferior mesenteric vein.
Detailed examination of GI tract –
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Portal vein and its tributaries:
Splenic vein, superior
mesenteric vein, inferior mesenteric vein, esophageal and gastric veins.
Celiac trunk: :
1) Left gastric artery
2) Common hepatic: a) hepatic proper: right gastric artery
b) Gastroduadenal: right gastroepiploic &
superior panceratoduadenal arteries (anterior
& posterior).
3) Splenic artery: left gastroepiploic artery.
4) Celiac lymph nodes.
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Superior mesenteric artery:
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Middle colic artery.
Inferior panceratoduadenal arteries (anterior and posterior).
Right colic artery.
Ileocolic artery: ileal & cecal branches(anterior & posterior cecal
arteries, appendicular branch).
8) Superior mesenteric lymph nodes
* intestinal arteries, arcades, vasa recta.
 Inferior mesenteric artery:
4) Left colic artery.
5) Sigmoid arteries.
6) Superior rectal artery.
 Bile duct: common bile duct, common hepatic duct, cystic duct,
main pancreatic duct & major duodenal papilla,
 Liver – bare area; falciform ligament; round ligament; ductus venosus,
lobes: right, left, quadrate and caudate; porta hepatis; coronary ligament; left
& right triangular ligaments, inferior vena cava.
 Stomach – greater & lesser curvature, cardiac part, fundus, body, pyloric
part & pyloric sphincter, gastric folds (rugae).
 Duodenum – pyloric part (ampula), descending part, horizontal part,
ascending part, ligament of Traitz.
 Spleen
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Small intestine – Jejunum & Ileum, ileocecal region.
Large intestine – cecum & vermiform appendix, ascending colon,
transverse colon, descending colon, sigmoid colon, tenia coli, haustra,
appendices epiploicae, semilunar folds.
Posterior Abdominal Structures –
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Aorta
o Celic, sup. Mesenteric, inf. mesenteric
o Inferior phrenic a.
 Superior suprarenal a.
o Testicular/ovarian vessels
o Renal vessels (Accessory renal a.?)
 Inferior suprarenal a.
o Middle Suprarenal a.
o Lumbar a
o Common iliac
 Internal, external iliac
IVC
Kidney
o Cortex
o Medulla
 Renal pyramids
 Renal column (of Bertin)
o Renal papillae
o Minor Calix
o Major Calix
o Renal Pelvis
o Ureter
Suprarenal glands
Transversus abdominis m.
Psoas major m.
Psoas minor m.
Iliacus m.
Quadratus lumborum m.
Diaphragm m.
o Lumbar part – right crus, left crus
o Vena cava foramen, esophageal hiatus, aortic hiatus
Lumbosacral nerve plexus: Subcostal n., iliohypogastric n., ilioinguinal n.,
Genitofemoral n., lateral cutaneous nerve of thigh, Femoral n., Obturator n.
Sympathetic trunk
The pelvis & Peritoneum –
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The bones and ligaments –
Ilium – ASIS, AIIS, PSIS, PIIS
Pubis – symphysis pubis
Ishium – ishial tuberosity, ishial spine
Sacrum& Coccyx
Greater sciatic foramen, lesser sciatic foramen, obturator foramen
Obturator membrane, obturator canal, sacrotuberous ligament, sacrospinous
ligament, promontory, pelvic brim, true & false pelvis.
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Fascia – Dartos fascia, Colles’ fascia, superficial perineal space, pelvic
fascia (parietal & visceral), bulk’s fascia (deep fascia of penis).
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Pelvic diaphragm – levator ani muscle (puborectalis, pubococcygeus,
iliococcygeus), coccygeus, piriformis, obturator internus.
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Superficial perineal muscles – ishiocavernosus, bulbosponginosus,
superficial transverse perineal muscle, perineal body, external anal sphincter.
Deep perineal space (male) –deep transverse perineal muscle,
sphincter urethra muscle, membranous part of urethra.
Deep perineal space (female) –deep transverse perineal muscle,
sphincter urethra muscle, sphincter urethravaginalis muscle.
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Peritoneal pouches male – rectovesical fossa.
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Peritoneal pouches female – Vesicouterine pouch, rectouterine
pouch
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The blood supply (male) –
Common iliac:
External iliac – deep circumflex, inferior epigastric.
Internal iliac- Posterior division: median sacral, superior gluteal,
lateral sacral, iliolumbar.
Anterior division: umbilical, obturator, superior vesical, inferior
vesical, inferior gluteal, internal pudendal,
middle rectal.
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The blood supply (female) –
Common iliac:
External iliac – deep circumflex, inferior epigastric.
Internal iliac- Posterior division: median sacral, superior gluteal,
lateral sacral, iliolumbar.
Anterior division: umbilical, obturator, superior vesical, inferior
vesical, uterine, inferior gluteal, internal
pudendal, middle rectal.
The nerve supply – lumbar plexus, sacral plexus, lumbosacral trunk,
obturator nerve, pudendal nerve.
Urinary bladder – body, fundus, interureteric crest, trigone of bladder,
left & right ureteric orifice, internal urethral orifice, detrusor muscle.
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Urethra (male) – spongy urethra, membranous urethra (and sphincter
urethra), prostatic urethra (urethral crest, colliculus seminalis, openings of
prostatic ducts, orifices of ejaculatory ducts, prostatic sinus).
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The reproductive system (male) –
1. Scrotum: layers - (skin, Dartos fascia, external spermatic fascia, cremaster
muscle, internal spermatic fascia, tunica vaginalis, tunica albugenia;
testis – lobule, septum, seminefrous tubule, rete testis, epididimus, ductus
deferens.
2. Prostate, seminal vesicles, ejaculatory duct.
3. Penis – Corpus cavernosum, corpus sponginosum, crus of penis, bulb of
penis, glans of penis, prepuce, frenulum, external urethral orifice, deep
dorsal vein and dorsal artery & nerve.
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The reproductive system (female) –
1. Uterus: Fundus, body, isthmus, cervix, anterior & posterior fornix, vagina.
2. Fallopian tubes: Isthmus, ampulla, infundibulum, fimbriae, abdominal &
uterine opening.
3. Ovary: proper ligament, suspensory ligament.
4. Broad ligament: mesometrium, mesosalpingx, mesovarium.
5. External genitalia: labium majus, labium minus, vestibule of vagina,
external urethral orifice, glans of clitoris, frenulum of clitoris, prepuce of
clitoris, vaginal orifice.