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Abdomen 2. 2.3 Peritoneal cavity 2.4 Liver and gallbladder 2.5 Stomach and spleen. Albert van Schoor GNK 288 (SA4 Anatomy dissection). 2.3 Peritoneal cavity and Disposition of abdominal organs. 2.3.1 Peritoneum 2.3.2 Organs and relations 2.3.3 Peritoneal specialisation

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2 3 peritoneal cavity 2 4 liver and gallbladder 2 5 stomach and spleen

Abdomen 2

2.3 Peritoneal cavity2.4 Liver and gallbladder2.5 Stomach and spleen

Albert van Schoor

GNK 288 (SA4 Anatomy dissection)

2 3 peritoneal cavity and disposition of abdominal organs
2.3 Peritoneal cavityand Disposition of abdominal organs

2.3.1 Peritoneum

2.3.2 Organs and relations

2.3.3 Peritoneal specialisation

2.3.4 Radiographic anatomy

2 3 1 peritoneum
2.3.1 Peritoneum
  • Define the terms:
    • Peritoneum,
    • Omentumand
    • Mesentery
  • Identify the parietal and visceral peritoneum
  • Identify and briefly discuss the attachments of the greater and lesser omentum
slide4

2.3.1 Peritoneum

  • Serous membrane that lines the abdominopelvic cavity and invests the viscera
  • Parietal peritoneum
  • Visceral peritoneum
  • Intraperitoneal organs
    • Stomach, spleen
  • Retroperitoneal organs
    • Kidneys, ascending & descending colon
slide5

2.3.1 Peritoneum

Mesentry of jejenum and ileum

Transverse mesoclolon

Sigmoid mesocolon

Meso-appendix

lesser omentum
Lesser Omentum

2.3.1 Peritoneum

Greater Omentum

slide7

2.3.1 Peritoneum

  • Innervation
  • Central aspect, diaphragmatic peritoneum
    • Phrenic nerve (C3-5) (referred pain)
  • Peripheral aspect, diaphragmatic peritoneum
    • Inter- and subcostal nerves (T7-T12)
  • Parietal peritoneum
    • T7-T12 and L1 (pain at precise point of stimulation)
  • Visceral peritoneum
    • Insensitive to mechanical stimulation
2 3 2 organs and relations
2.3.2 Organs and relations
  • Explain the functional anatomy of the mesentery, it’s position, vascular, lymphatic and neural contents
  • Explain how the abdomen is divided into a supracolic and infracolic compartment
  • Identify and briefly discuss the attachments of the mesentery of the small intestine to divide the infracolic compartment in two regions
slide9

2.3.2 Organs & relations

  • Mesentry:
    • double layer of peritoneum
    • serves as continuation of visceral and parietal peritoneum
    • provides a means for neurovascular communication between organ and body wall
slide10

2.3.2 Organs & relations

Transverse Mesoclolon

Mesentry of jejenum and ileum

Sigmoid mesocolon

slide11

2.3.2 Organs & relations

Supracolic

Infracolic

Right

Left

2 3 3 peritoneal specialisation
2.3.3 Peritoneal specialisation
  • Name and identify the peritoneal folds
  • Name and identify the peritoneal fossae
  • Name and identify the paracolic gutters
slide13

2.3.3 Peritoneal specialisation

Folds

Inferior to the umbilicus

  • Reflection of peritoneum
  • Raised from abdominal wall by underlying structure
  • Median umbilical fold

– urachus

  • Medial umbilical fold – obliterated umbilical artery
  • Lateral umbilical fold – inferior epigastric vessels
slide14

2.3.3 Peritoneal specialisation

  • Folds
  • Superior to the umbilicus
  • Falciform ligament
  • Round ligament of the liver (obliterated foetal umbilical vein)
slide15

2.3.3 Peritoneal specialisation

Fossae / Recess

  • Duodenal recess
  • Caecal recesses:
    • Superior ileocaecal
    • Inferior ileocaecal
    • Retrocaecal
  • Intersigmoid recess
  • Omental bursa
slide16

2.3.3 Peritoneal specialisation

  • Fossae / Recess
  • Duodenal recess
  • Duodenojejunal flexure
  • Formed by superior and inferior duodenal folds
  • Superior and inferior duodenal recesses
  • Paraduodenal recess
slide17

2.3.3 Peritoneal specialisation

  • Fossae / Recess
  • Caecal recesses:
    • Superior ileocaecal
    • Inferior ileocaecal
    • Retrocaecal
  • Formed by:
    • Caecal fold
    • Ileocaecal fold
    • Vascular fold
slide18

2.3.3 Peritoneal specialisation

  • Fossae / Recess
  • Caecal recesses:
    • Superior ileocaecal
    • Inferior ileocaecal
    • Retrocaecal
  • Formed by:
    • Caecal fold
    • Ileocaecal fold
    • Vascular fold
slide19

2.3.3 Peritoneal specialisation

  • Fossae / Recess
  • Intersigmoid recess
  • Meso-sigmoid attached to posterior abdominal wall in relation where the left ureter crosses the left common iliac artery
slide20

2.3.3 Peritoneal specialisation

Gutters

  • Right paracolic gutter
  • Left paracolic gutter
  • Right, between mesentry of jejenum and ileum and ascending colon (no exit)
  • Left, between mesentry of jejenum and ileum and descending colon (exit inferior)
2 3 3 peritoneal specialisation21
2.3.3 Peritoneal specialisation
  • Identify the following:
    • Gastrosplenic ligament,
    • Splenorenalligament,
    • Transverse and sigmoid mesocolon,
    • Ileocoecal fold,
    • Meso-appendix and
    • The mesenterium of the small intestine
2 3 3 peritoneal specialisation22
2.3.3 Peritoneal specialisation
  • Identify and describe the omental bursa (lesser sac) in respect of its relations, borders and entrance - the omental foramen
  • Identify the structures forming the borders of the omental foramen
  • Name and identify the subphrenic spaces
slide23

2.3.3 Peritoneal specialisation

  • Omental bursa
  • (left subhepatic space)
  • Superior recess
  • Inferior recess
  • Splenic recess
slide24

2.3.3 Peritoneal specialisation

  • Omental bursa
  • Superior recess
  • Anterior:
    • Lesser omentum
    • Caudate process of liver
  • Posterior:
    • Diaphragm
  • Right:
    • IVC
  • Left:
    • Oesophagus
slide25

2.3.3 Peritoneal specialisation

  • Omental bursa
  • Inferior recess
  • Anterior:
    • Stomach
    • Anterior 2 layers of greater omentum
  • Posterior:
    • Pancreas, transverse colon and mesocolon, poster 2 layers of greater omentum
slide26

2.3.3 Peritoneal specialisation

  • Omental bursa
  • Splenic recess
  • Anterior:
    • Gastrosplenic ligament
  • Posterior:
    • Splenorenal ligament
  • Left:
    • Hilum of the spleen
slide27

2.3.3 Peritoneal specialisation

  • Omental foramen
  • Connects greater sac (peritoneal cavity) and lesser sac (omental bursa)
slide28

2.3.3 Peritoneal specialisation

  • Omental foramen
  • Anterior:
  • Free border of lesser omentum:
    • Common bile duct (right)
    • Proper hepatic artery (left)
    • Hepatic portal vein (posterior)
slide29

2.3.3 Peritoneal specialisation

  • Omental foramen
  • Posterior:
    • Inferior vena cava
slide30

2.3.3 Peritoneal specialisation

  • Omental foramen
  • Superior:
    • Caudate lobe of liver
slide31

2.3.3 Peritoneal specialisation

  • Omental foramen
  • Inferior:
    • 1st part of duodenum
    • Common hepatic artery
2 3 3 peritoneal specialisation32
2.3.3 Peritoneal specialisation
  • Name and identify the subphrenic spaces
slide33

2.3.3 Peritoneal specialisation

  • Spaces
  • Right and left subphrenic spaces (separated by the falciform ligament)
  • Right subhepatic space (Morison’s pouch)
  • Left subhepatic space (omental bursa)
  • Extraperitoneal subphrenic space
slide34

2.3.3 Peritoneal specialisation

  • Right and left subphrenic spaces (separated by the falciform ligament)
slide35

2.3.3 Peritoneal specialisation

  • Right subhepatic space (Morison’s pouch)
slide36

2.3.3 Peritoneal specialisation

  • Extraperitoneal subphrenic space
2 3 4 radiographic anatomy
2.3.4 Radiographic anatomy
  • Identify the following structures on a plain erect abdominal X-ray:
    • ASIS,
    • lumbar vertebrae,
    • SI-joint,
    • large intestine,
    • diaphragm,
    • stomach with air in fundus of stomach,
    • liver,
    • psoas line

www.up.ac.za/academic/medicine/anatomy/current/sa4/week01e.html#radio

2 4 liver and gallbladder
2.4 Liver and gallbladder

2.4.1 Surface anatomy

2.4.2 Structure

2.4.3 Blood supply, nerve supply and lymph drainage

2 4 1 surface anatomy
2.4.1 Surface anatomy
  • Review the surface anatomy of the liver and gallbladder
  • Indicate where a liver biopsy should be done
slide40

2.4.1 Surface anatomy

  • Liver
  • Right, midaxillary line:
    • 7th rib almost to right iliac crest
  • Right, midclavicular plane:
    • 5th rib cartilage to 9th costal cartilage
  • Left, midclavicular plane:
    • 2.5cm short 5th intercostal space and left nipple
slide41

2.4.1 Surface anatomy

  • Gallbladder
  • Inferior to 9th costal cartilage on right
  • Lateral to semilunar line (lateral border of rectus abdominis)
  • Approx. hands breadth from midline
2 4 2 structure
2.4.2 Structure
  • Name and identify the borders and surfaces of the liver
  • Name and identify the lobes, segments, fissures with their contents Identify the subhepatic and subphrenic spaces, and their possible implication in the spread of infection
slide44

2.4.2 Structure

Diaphragmatic surface

Visceral surface

slide46

2.4.2 Structure

  • Colon
  • Kidney
  • Duodenum
  • Stomach
2 4 2 structure47
2.4.2 Structure
  • Name and identify the following:
    • Triangular ligaments,
    • Coronary ligaments,
    • Falciform ligament,
    • Lesser omentum,
    • Round ligament of the liver and
    • Ligamentum venosum
2 4 2 structure48
2.4.2 Structure
  • Identify, schematically illustrate and discuss the extrahepatic bile ducts as follows:
    • Origin,
    • Course,
    • Outlet and
    • Relations to the pancreas head and duodenum
  • Name and identify the extrahepatic bile ducts on radiographs
slide49

2.4.2 Structure

Right and left hepatic ducts

Common hepatic duct

Cystic duct

(Common) bile duct

Main pancreatic duct of Wirsung

Ampulla of Vater with the sphincter of Oddi

2 4 3 blood supply
2.4.3 Blood supply
  • Discuss and identify the arterial blood supply and venous drainage of the liver and gallbladder
  • Take note of variations in the arterial blood supply of the liver and gallbladder
slide52

2.4.3 Blood supply

  • Left & right hepatic arteries
  • Well-oxygenated blood
  • Hepatic portal vein
  • Poorly oxygenated blood, nutrient-rich blood from GI tract
2 5 stomach and spleen
2.5 Stomach and spleen

2.5.1 Surface anatomy

2.5.2 Structure

2.5.3 Blood supply, nerve supply and lymph drainage

2.5.4 Radiographic anatomy

2 5 1 surface anatomy
2.5.1 Surface anatomy
  • Review the surface anatomy of the stomach and spleen in relation to the anterior abdominal wall
slide55

2.5.1 Surface anatomy

  • Stomach
  • Cardiac part:
    • Deep to 7th costal cartilage, 2.5cm to the left of the midline
  • Pylorus:
    • On transpyloric plane, 2.5cm to the right of the midline
    • Vertebral height L1 / L2
  • Fundus:
    • Superior of a plane that extends horizontally from the cardia
  • Body:
    • Lies inferior of the above-mentioned plane
slide56

2.5.1 Surface anatomy

  • Spleen
  • In relation to the 9th - 11th rib in the midaxillary line
2 5 2 structure
2.5.2 Structure
  • Name and identify the various regions, curvatures and surfaces of the stomach. Identify these also on radiographs
  • Identify and briefly describe the general and peritoneal relations of the stomach
slide58

2.5.2 Structure

Cariac zone

Fundus

Cardio-oesophageal orifice

Pylorus

Body

Gastric

and

fundic zones

Pyloric zone

slide59

2.5.2 Structure

  • Anterosuperior relations:
    • Left lobe of liver
    • Diaphragm
    • Anterior abdominal wall
    • Left costal margin
slide60

2.5.2 Structure

  • Postero-inferior relations:
    • Omental bursa with
    • Transverse colon and mesocolon
    • Pancreas
    • Spleen
    • Coeliac artery
    • Left kidney and suprarenal gland
    • Coeliac plexus
    • Coeliac ganglia
    • Diaphragm
2 5 2 structure61
2.5.2 Structure
  • Identify and briefly discuss the structure and surfaces of the spleen
  • Identify and briefly discuss the relations of the spleen to: ribs, stomach, pancreas, kidney, transverse colon, suprarenal gland
  • Identify the possible routes of surgical access to the lesser sac: omental foramen, directly through the lesser omentum, posterior
slide63

2.5.2 Structure

Posterior

Anterior

2 5 3 blood supply nerve supply and lymph drainage
2.5.3 Blood supply, nerve supply and lymph drainage
  • Identify and briefly discuss the arterial supply and venous drainage of the stomach and spleen
  • Schematically illustrate the coeliac trunk and it's branches
slide65

2.5.3 Blood & nerve supply, Lymph drainage

Coeliac trunk

  • Common hepatic artery
    • Gastroduodenal artery
      • Anterior superior pancreaticoduodenal artery
      • Right gastro-omental artery
    • Proper hepatic artery
      • Right gastric artery
      • Right hepatic artery
        • Cystic artery
      • Left hepatic artery
slide66

2.5.3 Blood & nerve supply, Lymph drainage

Coeliac trunk

  • Splenic artery
    • Left Gastro-omental artery
    • Short gastric artery
slide67

2.5.3 Blood & nerve supply, Lymph drainage

Coeliac trunk

  • Left gastric artery
2 5 3 blood supply nerve supply and lymph drainage68
2.5.3 Blood supply, nerve supply and lymph drainage
  • Identify and briefly discuss the vagus nerve as follows:
    • Abdominal entrance (anterior and posterior vagus trunks),
    • Prominent plexuses and
    • Branches and extent of abdominal supply
  • Identify the intra-abdominal part of the oesophagus 
slide69

2.5.3 Blood & nerve supply, Lymph drainage

  • Vagus nerve (X)
  • Enters abdomen at T10 together with oesophagus
  • Parasympathetic supply to GI tract as far as the left colic flexure
  • Contributions to
    • Cardiac plexus
    • Oesophageal plexus
    • Aortic plexus
    • Coeliac plexus
  • Branches:
    • Oesophageal
    • Gastric
    • Pancreatic
    • Branches to gallbladder
    • Branches to intestine as far as the left colic flexure
slide70

2.5.3 Blood & nerve supply, Lymph drainage

  • Left vagus nerve (X) – Ant. vagal trunk
  • Branches:
    • Oesophageal branches
    • Gastric branches
    • Hepatic branches to hepatic portal vein
    • Pyloric branches
slide71

2.5.3 Blood & nerve supply, Lymph drainage

  • Right vagus nerve (X) – Post. vagal trunk
  • Branches:
    • Oesophageal branches
    • Gastric branches
    • Coeliac branches to coeliac plexus
    • Pyloric branches
2 5 4 radiographic anatomy
2.5.4 Radiographic anatomy
  • Identify the stomach and air in the fundus of the stomach on a plain erect abdominal X-ray
  • Identify the stomach on a barium meal

www.up.ac.za/academic/medicine/anatomy/current/sa4/week01e.html#radio