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The Abdomen Stuart M Bunt Functional Anatomy 212 Overview Embryology Revision Foregut, Midgut and Hindgut suspended by the dorsal mesentary, initially straight Ventral mesentary connects stomach and ant. abd. wall, rest of gut free anteriorly Mesentary supplies blood and nerves to gut between layers of peritoneum Complex adult layout due to 270o rotation Blood Supply to Abdominal Organs Foregut Celiac trunk Midgut Superior artery mesenteric Hindgut Inferior artery mesenteric Rectum Internal iliac artery (pudendal and rectal arteries) Stomach Variable size and shape, distensible J shaped related to body form Lesser and greater curvature gastroesophageal junction fundus,cardiac part, body, pyloric part pyloric antrum and sphincter rugae and gastric pits Blood Supply of Stomach Superior Mesenteric Artery Territory Inferior mesenteric artery territory Venous system Portal Vein Splenic vein inferior mesenteric vein Superior mesenteric vein Gastric veins Hepatic Veins Inf. Vena Cava Anastomoses Stomach rotates and distends Front Dorsal Mesentary Ventral Mesentary Back Splenic tissue Epiploic Foramen Omentum Omentum Under the OMENTUM The Peritoneal cavity is divided in two Rotation of stomach forms the greater omentum (allows stomach distension and infection control) Omental bursa or Lesser sac is inside omentum (a potential space) Lesser omentum runs from stomach to liver (note free lower border above epiploic foramen contains portal vein, hepatic artery and bile duct Mesenteries are important:- Paracolic gutters channel fuid Stop herniation due to bipedal posture Supply blood/nerves Sensitive to stretch Contain infection Useful in surgery On return some gut fuses with posterior wall Diaphragm 1 2 Duo. Asc. Colon 1.lienorenal lig. 2.trans. mesocolon 3.mesentary proper 4.mes. of sig. colon 3 4 Rectum Desc. Colon Retro-peritoneal Oesophagus 10 inches from pharynx to stomach narrow at cricoid cartilage where left bronchus crosses oesophageal hiatus in diaphragm mucous membrane folded (normally collapsed) stratified squamous epithelium striated above smooth below trachea on right, lower aorta on left medial to L. lung, behind left atrium Duodenum first 12 inches of gut four parts form C shape duodenal cap radiologically identified, ulcers form here mobile descending part pancreatic and bile ducts horizontal part crosses psoas, IVC and aorta crossed by mesentery, sup mesen. art. ascending part Jejunum 2/5ths of small intestine gradual transition to ileum many small villi increasing numbers of lymph nodules no submucosal glands lacteals in each villus columnar epithelium Ileum distal 3/5ths of intestine narrower, thinner, less vascular, slower, more fat and arterial arcades in mesentery than jejunum. Peyer’s patches of lymphoid tissue Colon ascending colon retroperitoneal right colic or hepatic flexure transverse colon (mesocolon) droops towards pelvis? left colic or splenic flexure descending colon retroperitoneal pelvic or sigmoid colon S shaped Colonoscopy Barium enema outlines structures on X-rays Appendix The Liver Largest Gland (one of largest organs) Right upper abdomen under diaphragm Grows as outgrowth of gut plus mesoderm Diaphragmatic surface Visceral surface down and left related to stomach, duodenum, r. kidney, r. colonic flexure bears gall bladder Biliary System R and L Hepatic ducts Common hepatic duct Joined by cystic duct (to gall bladder) Forms bile duct (common bile duct) Gall Bladder body and fundus, salts and water absorbed store for bile, released in response to cholecystokinin Pancreas Pancreas Head in concavity of duodenum body across vertebrae tail reaches the spleen pancreatic duct (+ accessory?) ampulla duodenal papilla Spleen The Spleen Lies in left hypochondriac region between gastric fundus and diaphragm at level of 9th-10th rib (not normally palpable) Soft, friable, highly vascular, dark purple Diaphragmatic surface convex and smooth facing diaphragm Visceral surface gastric, renal, pancreatic and colic impressions The Spleen (2) Hilum of spleen long fissure through which vessels and nerves pass Suspended from stomach by gastrolienal ligament (contains short gastric and left gastro-epiploic branches of spenic artery) Suspended from posterior abdominal wall by lienorenal ligament Covered by adherent peritoneum Relationship to the Spleen Kidneys In fat capsule Suprarenal glands superiorly Direct Arterial and venous supply Kidney Internal Structure Renal pyramids between renal columns Renal Cortex Renal papillae drain into minor calix Major calix join to form renal pelvis Ureter as outlet Kidneys External View Artery - Vein - Ureter Relationships of the Kidneys