V ABDOMEN AND PELVIS

Abdomen and Pelvis

Adult skeleton of the abdominal region – from the front

Image

1  Xiphoid process

2  Sixth (VI) rib

3  Seventh (VII) rib

4  Eighth (VIII) rib

5  Ninth (IX) rib

6  Tenth (X) rib

7  Eleventh (XI) rib

8  Twelfth (XII) rib

9  Sixth costal cartilage

10  Seventh costal cartilage

11  Tenth (TX) thoracic vertebra

12  Eleventh (TXI) thoracic vertebra

13  Twelfth (TXII) thoracic vertebra

14  First (LI) lumbar vertebra

15  Second (LII) lumbar vertebra

16  Third (LIII) lumbar vertebra

17  Fourth (LIV) lumbar vertebra

18  Fifth (LV) lumbar vertebra

19  Sacrum (sacral vertebrae I–V)

20  Coccyx (coccygeal vertebrae I–IV)

21  Hip bone

22  Anterior superior iliac spine

23  Anterior inferior iliac spine

24  Obturator foramen

25  Pubic symphysis

26  Iliac crest

27  Sacro-iliac joint

28  Pubic tubercle

29  Head of femur

30  Neck of femur

31  Shaft of femur

Abdomen, muscles of the anterior wall – from the front

The nine regions of the abdomen:

A  Upper central – epigastric region

B  Central           – umbilical region

C  Lower central – pubic region

D  Right – hypochondrium – left

E  Right – lateral (flank) region – left

F  Right – inguinal (groin) region – left

Image

1  Xiphoid process of sternum

2  Sternocostal part of pectoralis major

3  Serratus anterior

4  External oblique

5  External oblique aponeurosis

6  Rectus abdominis

7  Tendinous intersection of rectus abdominis

8  Linea alba

9  Rectus sheath

10  Umbilicus

11  Anterior cutaneous nerve (eighth intercostal)

12  Anterior cutaneous nerve (tenth intercostal)

13  McBurney’s point (circled)

14  Posterior layer of oblique aponeurosis

15  Linea semilunaris

16  Anterior layer of oblique aponeurosis

17  Superficial inguinal lymph nodes

18  Pubic tubercle

19  Pyramidalis

20  Pubic symphysis

21  Mons pubis

22  Inguinal ring (position of)

23  Ilioinguinal nerve

24  Anterior superior iliac spine

25  Inguinal ligament

26  Tensor fascia latae

27  Transpyloric plane

28  Intertubercular plane

McBurney’s point:

  Is an important site locatable on the surface of the anterior abdominal wall.

  It identifies the usual internal location of the base of the appendix.

  The point lies one-third of the way along a direct line from the right anterior superior iliac spine of the hip bone to the umbilicus.

Abdominal viscera I – from the front Structures of the internal abdominal wall – from below

The nine regions of the abdomen:

A  Upper central – epigastric region

B  Central           – umbilical region

C  Lower central – pubic region

D  Right – hypochondrium – left

E  Right – lateral (flank) region – left

F  Right – inguinal (groin) region – left

Image

1  Right lobe of liver

2  Gall bladder

3  Falciform ligament

4  Left lobe of liver

5  Duodenum, superior (1st part)

6  Body of stomach

7  Greater omentum

8  Terminal part of ileum

9  Caecum

10  Small intestine (coils of jejunum and ileum)

11  Transpyloric plane

12  Intertubercular plane plane

13  Inferior epigastric artery and vein

14  Rectus abdominis

15  Arcuate line (free edge of posterior rectus sheath)

16  Umbilicus

17  Rectus sheath

18  Transversus abdominis

19  Internal oblique

Abdominal viscera II, with greater omentum reflected superiorly – from the front

Image

1  Left lobe of liver

2  Body of stomach

3  Greater omentum

4  Transverse colon

5  Mesentary

6  Jejunum

7  Ileum

8  Caecum

The passage of food via the digestive alimentary tract

From the:

  Mouth – to the

  Pharynx – approximately 12–14 cm in length, extending from the base of the skull to the sixth (CVI) cervical vertebra; then into the

  Oesophagus – approximately 25 cm in length, extending from the sixth (CVI) cervical vertebra, passing through the diaphragm at the level of the tenth (TX) thoracic vertebra; to the

  Stomach – at the level of the ninth (TIX) thoracic vertebra (gastro-oesophageal junction); then through the stomachs fundus, body and pylorus; to the

  Small intestine – which is approximately 6–7 metres in total length from the pylorus of the stomach to the ileocaecal junction;

  duodenum – approximately 20–25 cm in total length; through the superior (1st part) 5 cm, descending (2nd part) 8–10 cm, inferior (3rd part) 10 cm, and ascending (4th part) 2.5 cm; to the

  jejunum – approximately 2.5 metres in length; and

  ileum – approximately 3.5 metres in length; to the

  Large intestine – which is approximately 1.5 metres in total length from the caecum to the anus;

  caecum – then from the ilocaecal junction, location of the appendix, to the

  colon – through its ascending, transverse, descending and sigmoid parts; to the

  rectum – and into

  anal canal – as food waste (faeces); finally exiting the

  anus – after travelling an overall distance from mouth to anus of approximately 9 metres.

Transverse section through the abdomen at the level of the second (LII) and third (LIII) lumbar vertebra – from below

Image

1  Linea alba

2  Rectus abdominis

3  External oblique

4  Internal oblique

5  Transversus abdominis

6  Latissimus dorsi

7  Quadratus lumborum

8  Erector spinae

9  Psoas major

10  Cauda equina within vertebral canal

11  Intervertebral disc between the second (LII) and third (LIII) lumbar vertebra

12  Root of second lumbar nerve

13  Left ureter

14  Inferior mesenteric vein

15  Left testicular artery and vein

16  Para-aortic lymph nodes

17  Aorta

18  Inferior vena cava

19  Right sympathetic chain

20  Right ureter

21  Right testicular artery and vein

22  Lower pole of right kidney

23  Renal fascia

24  Ascending colon and right colic (hepatic) flexure

25  Right lobe of liver

26  Greater omentum

27  Transeverse colon

28  Jejunum

29  Mesentary with mesenteric vessels

30  Superior mesenteric artery and vein

31  Duodenum, inferior (3rd part)

32  Descending colon

Caecum, terminal ileum (the iliocaecal junction) and vermiform appendix – from the front

Image

1  Caecum

2  Anterior taenia coli (taenia libra)

3  Ascending colon

4  Ileocaecal junction

5  Terminal ileum

6  Base of vermiform appendix

7  Mesentery of vermiform appendix

8  Tip of vermiform appendix

9  Ileocaecal artery and vein

The vermiform appendix:

  Usually has an internal diameter of 0.5 cm.

  Length varies between 2 and 20 cm, with an average of 8 cm.

  Position is variable but consensus of research data gives:

  Retrocolic and retrocaecal 70%.

  Subcaecal and pelvic 20%.

  Retro-ileal and pre-ileal 5%.

Transverse section through the abdomen at the level of the first (LI) lumbar vertebra – from below

Image

1  Latissimus dorsi

2  Serratus posterior inferior

3  Erector spinae

4  Quadratus lumborum

5  Left kidney

6  Left ureter

7  Cauda equina within vertebral canal

8  Body of first (LI) lumbar vertebra

9  Right crus of diaphragm

10  Right sympathetic chain

11  Inferior vena cava

12  Cisterna chyli

13  Aorta

14  Common bile duct

15  Duodenum

16  Gall bladder

17  Commencement of right ureter

18  Right kidney

19  Twelfth (XII) rib

20  Renal fascia

21  Eleventh (XI) rib

22  Tenth (X) rib

23  Right lobe of liver

24  Ninth costal cartilage

25  Left lobe of liver (medial segment)

26  Linea alba

27  Falciform ligament

28  Antrum of stomach

29  Transverse colon

30  Jejunum

31  Head of pancreas

32  Superior mesenteric vein

33  Superior mesenteric artery

34  Greater omentum

35  Para-aortic lymph node

36  Inferior mesenteric vein

37  Descending colon

38  Internal oblique

39  External oblique

40  Rectus abdominis

41  Transverse abdominis

42  Left lobe of liver (lateral segment)

43  Portion of disc between first (LI) and second (LII) lumbar vertebra

Upper abdominal viscera I, with removal of most of the small and all of the large intestine – from the front and slightly below

A  Right subphrenic space

B  Right subhepatic space

C  Left subphrenic space

D  Left subhepatic space

Image

1  Right inferior surface of the dome of diaphragm

2  Left inferior surface of the dome of diaphragm

3  Right lobe of liver

4  Quadrate lobe of liver

5  Falciform ligament

6  Left lobe of liver

7  Fundus of gall bladder

8  Body of gall bladder

9  Neck of gall bladder

10  Cystic duct

11  Common hepatic duct

12  Portal vein

13  Common hepatic trunk

14  Left gastric artery

15  Anterior vagal trunk

16  Oesophagus

17  Gastro-oesophageal junction

18  Fundus of stomach

19  Splenic artery

20  Spleen

21  Body of stomach

22  Lesser curvature of stomach

23  Greater curvature of stomach

24  Pyloric antrum

25  Pylorus of stomach

26  Duodenum, superior (1st part)

27  Head of pancreas

28  Uncinate process of pancreas

29  Body of pancreas

30  Tail of pancreas

31  Lower pole of left kidney

32  Greater omentum

33  Right gastro-epiploic artery

34  Aorta

35  Inferior vena cava

36  Lower pole of right kidney

37  Duodenum, descending (2nd part)

38  Major duodenal papilla with the common opening for the bile and main pancreatic duct (ampulla of Vater)

39  Minor duodenal papilla with the opening of the accessory pancreatic duct

Upper abdominal viscera II, with removal of most of the small and all of the large intestine – from the front and slightly below

A  Right subphrenic space

B  Right subhepatic space

C  Left subphrenic space

D  Left subhepatic space

Image

1  Right inferior surface of the dome of diaphragm

2  Left inferior surface of the dome of diaphragm

3  Right lobe of liver

4  Quadrate lobe of liver

5  Falciform ligament

6  Left lobe of liver

7  Fundus of gall bladder

8  Body of gall bladder

9  Neck of gall bladder

10  Cystic duct

11  Common hepatic duct

12  Splenic artery

13  Left gastric artery

14  Oesophagus

15  Gastro-oesophageal junction

16  Fundus of stomach

17  Body of stomach

18  Lesser curvature of stomach

19  Greater curvature of stomach

20  Pyloric antrum

21  Pylorus of stomach

22  Superior (1st part) of duodenum

23  Descending (2nd part) of duodenum

24  Inferior (3rd part) of duodenum

25  Ascending (4th part) of duodenum

26  Head of pancreas

27  Body of pancreas

28  Tail of pancreas

29  Spleen

30  Lower pole of right kidney

31  Gastro-epiploic vessels within greater omentum

32  Aorta

33  Inferior vena cava

34  Lower pole of left kidney

Stomach, incised along the length of the greater curvature and opened (as a book), to expose internal structures in a coronal plane, thus views are:

A  Anterior portion reflected superiorly, from behind

B  Posterior portion, from the front

Image

1  Greature curvature of stomach

2  Folds of mucous membrane (gastric rugae)

3  Body of stomach

4  Oesophagus at the gastro-oesophageal junction

5  Cardiac part of stomach

6  Gastric canal

7  Pyloric antrum

8  Pyloric canal

9  Pylorus (gastroduodenal junction)

10  Fundus of stomach

11  Muscular coat of stomach

The stomach:

  Is shaped like the letter J.

  The gastro-oesophageal junction (upper opening into the stomach), lies to the left of the midline at the level of the ninth (TIX) thoracic vertebra.

  The gastroduodenal junction at the pylorus (lower opening out of the stomach), lies to the right of the midline at the level of the first (LI) lumbar vertebra.

  Upper border has the lesser curvature.

  Lower border has the greater curvature.

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Jan 22, 2018 | Posted by in ANATOMY | Comments Off on V ABDOMEN AND PELVIS

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