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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