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ABDOMEN. Lu Xiaoli Regional Anatomy & Operative Surgery China Medical University . BOUNDARIES . Abdominopelvic Cavity Abdominal Cavity Pelvic Cavity. P242-fig.4.21. DIVISIONS. P242-fig.4.22. P243-fig.4.23. P243-fig.4.23.

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abdomen

ABDOMEN

Lu Xiaoli

Regional Anatomy & Operative Surgery

China Medical University

slide3
Abdominopelvic Cavity
  • Abdominal Cavity
  • Pelvic Cavity

P242-fig.4.21

divisions
DIVISIONS

P242-fig.4.22

slide7
Which one of the following is not one of the 9 regions of the abdomen?
  • Right hypochondriac
  • Left inguinal or iliac
  • Epigastric
  • Right upper
  • Left lumbar
slide8
Which of the following is NOT true concerning the peritoneal cavity?
  • The peritoneal cavity is a potential space.
  • The peritoneal cavity contains organs inside of it.
  • The peritoneal cavity is filled with fluid that lubricates its contents.
  • The parietal and visceral peritoneum are linings of the peritoneal cavity.
slide9
The usual location for an appendectomy incision is the:
  • left lower quadrant
  • left upper quadrant
  • right lower quadrant
  • right upper quadrant
slide10
You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region:
slide11
Epigastric
  • Left inguinal
  • Left lumbar
  • Right hypochondrial
  • Hypogastric
abdominal wall13
Abdominal wall

Anterolateral abdominal wall

Posterior abdominal wall

layers
Skin

Superficial fascia

Deep fascia

Muscles

Transversalis fascia

Extraperitoneal fascia

Peritoneum

LAYERS
superficial fascia
Superficial fascia
  • Camper’s fascia
  • Scarpa's fascia

P245-fig.4.25~4.26

superficial arteries
SUPERFICIAL ARTERIES
  • Lateral
    • Posterior intercostal a.
    • Subcostal a.
    • Lumbar a.
  • Median
    • Epigastric a.
    • hypogastric a.
  • Inferior
    • Superficial epigastric a.
    • Superficial iliac a.

P255-fig.4.39

superficial veins
Superficial veins

lateral thoracic

subclavian

thoracoepigastric

portal

paraumbilical

S epigastric

femoral

S circumflex iliac

innervations
INNERVATIONS
  • Intercostal Nerve
  • T7-T12
  • 10th Intercostal Nerve
muscles
MUSCLES

Anterior Group

Lateral Group

  • External Oblique
  • Internal Oblique
  • Transversus
  • Rectus Abdominis
  • Pyramidalis
rectus abdominis
RECTUS ABDOMINIS
  • Tendinous Intersection (3)
  • Linea Semilunaris
arteries
Arteries
  • 5 intercostal arteries
  • subcostal arteries
  • 4 lumbar arteries
  • Superior epigastric artery—internal thoracic artery
  • Inferior epigastric artery -external iliac artery
  • Deep iliac circumflex artery- external iliac artery
innervations35
Innervations
  • Intercostal n.
    • Anterior cutaneous branch
    • Lateral cutaneous branch
slide36

T7-12 thoracic n.

  • Iliohypogastric n.
  • Ilioinguinal n.
  • Genitofemoral n.
umbilical folds
Umbilical Folds
  • Median

-- median umbilical lig.

  • Medial

-- chorda arteriae umbilicalis

  • Lateral

-- inferior epigastric a. & v.

incisions
INCISIONS
  • Longitudinal
    • Midline
    • Paramedian
    • Transrectal
  • Oblique
    • Subcostal
    • McBurney’s
  • Transverse
    • Pfannenstiel
  • Combined
    • Thoracal-abdominal
slide43
The inferior border of the rectus sheath posteriorly is called the:
  • Falx inguinalis
  • Inguinal ligament
  • Internal inguinal ring
  • Arcuate line
  • Linea alba
slide44
Following an emergency appendectomy your patient complained of having paresthesia (numbness) of the skin at the pubic region. The most likely nerve that has been injured during the operation is:
  • Genitofemoral
  • Iliohypogastric
  • Subcostal
  • Spinal nerve T10
  • Spinal nerve T9
slide45
An obstetrician decides to do a Caesarean section on a 25-year-old pregnant woman. A transverse suprapubic incision is chosen for that purpose. All of the following abdominal wall layers will be encountered during the incision EXCEPT the:
slide46
Anterior rectus sheath
  • Posterior rectus sheath
  • Rectus abdominis muscle
  • Skin and subcutaneous tissue
  • Transversalis fascia, extraperitoneal fat, and peritoneum
slide47
Surgical approaches to the abdomen sometimes necessitate a midline incision between the two rectus sheaths, i.e., through the:
  • Linea aspera
  • Arcuate line
  • Semilunar line
  • Iliopectineal line
  • Linea alba
slide48
The internal thoracic artery is sometimes surgically cut near the caudal end of the sternum and used to supply blood to a region of the heart. In these cases, maintenance of adequate blood flow to the rectus abdominis may be dependent on increased flow through which artery?
slide49
Superficial epigastric
  • Inferior epigastric
  • Umbilical
  • Superficial circumflex iliac
  • Deep circumflex iliac
layers53
LAYERS
  • Skin
  • Superficial layer
    • Camper’s
    • Scarpa’s
external oblique abdominis
External Oblique Abdominis

Inguinal Lig.

Lacunar Lig.

Pectineal Lig. (cooper’s Lig.)

slide55

Reflected Ligament

Intercrural Fibers

Lateral Crus

Superficial Inguinal Ring

Medial Crus

slide56
Internal oblique abdominis
  • transverse abdominis
slide57

Cremaster

Conjoint Tendon

slide58
Conjoint Tendon

Cremaster

transverse abdominal fascia
Transverse Abdominal Fascia

abdominal inguinal ring

(deep inguinal ring)

slide60
Extraperitoneal fascia
  • Parietal peritoneum
    • Medial inguinal fossa
    • lateral inguinal fossa
slide62

4 lunar month

11 weeks

8 lunar month

inguinal canal
Inguinal Canal
  • Roof
    • internal oblique abdominis
    • transversus abdominis
  • Floor
    • inguinal ligament
    • lacunar ligament
  • anterior wall
    • external abdominal oblique aponeurosis
    • internal abdominal oblique aponeurosis
  • posterior wall
    • transversalis fascia
    • conjoint tendon (falx inguinalis)
contents male
Contents (male)
  • spermatic cord
    • arteries: testicular artery, deferential artery, cremasteric artery
    • nerves: genital branch of the genitofemoral nerve, nerve to cremaster, sympathetic nerves
    • vas deferens
    • pampiniform plexus
    • lymphatic vessels
  • ilioinguinal nerve
contents female
Contents (female)
  • round ligament of the uterus
  • ilioinguinal nerve
spermatic fascia
Spermatic Fascia
  • Internal spermatic fascia
    • Transversalis fascia
  • Middle
    • cremaster
  • External
    • aponeurosis of external oblique abdominis
hernia
HERNIA
  • Inguinal hernia
    • Indirect
    • Direct
slide72
A medical student was asked by her preceptor to palpate the margin of the superficial inguinal ring of a healthy male patient. After passing her finger down the edge of the medial crus of the superficial inguinal ring, she felt a bony protuberance deep to the lateral edge of the spermatic cord, which she correctly identified as the :
slide73
pecten pubis
  • pubic symphysis
  • pubic tubercle
  • iliopubic eminence
  • iliopectineal line
slide74
In order to reduce a hernia (return it to the abdominal cavity), a surgeon finds it necessary to ligate an artery in the extraperitoneal connective tissue (preperitoneal fat) running vertically just medial to the bowel as the bowel passes through the abdominal wall. This artery is the:
slide75
Deep circumflex iliac
  • Inferior epigastric
  • Superficial circumflex iliac
  • Superficial epigastric
  • Superficial external pudendal
slide76
During a laparoscopic examination of the deep surface of the lower anterior abdominal wall (using a lighted scope on a thin tube inserted through the wall), the attending physician noted something of interest and asked the young resident to look at the medial inguinal fossa. To do so, the young doctor would have to look at the area between the:
slide77
inferior epigastric artery and urachus
  • medial umbilical ligament and urachus
  • inferior epigastric artery and lateral umbilical fold
  • medial umbilical ligament and inferior epigastric artery
  • median umbilical ligament and medial umbilical ligament
slide78
If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
slide79
Camper's and Scarpa's fascias
  • External abdominal oblique and internal abdominal oblique muscles
  • Internal abdominal oblique and transversus abdominis muscles
  • Skin and deep fascia of the abdominal wall
  • Tranversus abdominis muscle and peritoneum
slide80
Which structure passes through the deep inguinal ring?
  • Iliohypogastric nerve
  • Ilioinguinal nerve
  • Inferior epigastric artery
  • Medial umbilical ligament
  • Round ligament of the uterus
slide81
A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region?
slide82
Deep inguinal ring
  • Lateral inguinal fossa
  • Medial inguinal fossa
  • Superficial inguinal ring
  • Supravesical fossa
slide83
In a female with an indirect inguinal hernia, the herniated mass lies along side of which structure as it traverses the inguinal canal?
  • Iliohypogastric nerve
  • Inferior epigastric artery
  • Ovarian artery and vein
  • Pectineal ligament
  • Round ligament of the uterus
slide84
The skin of the mons pubis is supplied by which nerve?
  • Anterior scrotal
  • Anterior labial
  • Femoral branch of the genitofemoral
  • Iliohypogastric nerve
  • Subcostal nerve
slide85
During your peer presentation of the inguinal region dissection, you would indicate the position of the deep inguinal ring to be:
  • Above the anterior superior iliac spine
  • Above the midpoint of the inguinal ligament
  • Above the pubic tubercle
  • In the supravesical fossa
  • Medial to the inferior epigastric artery
slide86
A 45-year-old porter develops a direct inguinal hernia. If the hernia extended through the superficial inguinal ring, it would be surrounded by all of the abdominal wall layers EXCEPT the:
slide87
External spermatic fascia
  • Internal spermatic fascia
  • Peritoneum and extraperitoneal connective tissue
  • Weak fascia of the transversus abdominis muscle lateral to the falx
slide88
The boundaries of the inguinal triangle include all except:
  • Arcuate line
  • Inferior epigastric vessels
  • Inguinal ligament
  • Lateral border of rectus abdominus muscle
slide89
The superficial inguinal ring is an opening in which structure?
  • External abdominal oblique aponeurosis
  • Falx inguinalis
  • Internal abdominal oblique muscle
  • Scarpa's fascia
  • Transversalis fascia
slide90
Which nerve passes through the superficial inguinal ring and may therefore be endangered during inguinal hernia repair?
  • Femoral branch of the genitofemoral
  • Ilioinguinal
  • Iliohypogastric
  • Obturator
  • Subcostal
slide91
During exploratory surgery of the abdomen, an incidental finding was a herniation of bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric vessels. These boundaries defined the hernia as a(n):
slide92
Congenital inguinal hernia
  • Direct inguinal hernia
  • Femoral hernia
  • Indirect inguinal hernia
  • Umbilical hernia