腹部局部解剖學(xué)Abdomen課件

1、Abdominal wall山東大學(xué)醫(yī)學(xué)院 解剖教研室李振華Abdominal wall山東大學(xué)醫(yī)學(xué)院 解剖教研室Anterior wall Layers ( from superficial to deep)Skin Superficial fasciaAnterolateral musclesTransversalis fascia 腹橫筋膜Extraperitoneal fascia 腹膜下筋膜Parietal peritoneum 壁腹膜 Anterior wall Layers ( from suSuperficial fasciadivisions below umbilicusS

2、uperficial fatty layer (Campers)Membranous layer (Scarpas)Superficial fasciadivisions b Muscles of abdomenAnterolateral groupObliquus externus absominis 腹外斜肌Oblequus enternus abdominis腹內(nèi)斜肌Transversus abdominis腹橫肌Rectus abdominis 腹直肌 Muscles of abdomenAnterolaterPosterior group Quadiatus lumborum 腰方肌

3、Psoas major 腰大肌Posterior group Obliquus externus absominis 腹外斜肌General direction of fibers: downward, forward and medially (run down and inward)StructuresInguinal ligament 腹股溝韌帶Lacunar ligament 腔隙韌帶Superficial inguinal ring 腹股溝淺環(huán) triangular-shaped defect in aponeurosis of obliquus externus abdominis

4、 above pubic tubercleObliquus externus absominis 腹部局部解剖學(xué)Abdomen課件Obliquus internus abdominis 腹內(nèi)斜肌Deep to obliquus externus abdominisGeneral direction of fibres: upwards, forwards and mediallyObliquus internus abdominis Transversels abdominis 腹橫肌Deep to obliquus internus Transversels abdominis 腹橫肌Dee

5、pInguinal falx 腹股溝鐮: arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睪肌: around the spermatic cord and testisInguinal falx 腹股溝鐮: arch over Rectus abdominis 腹直肌Position: lie on to either of midlineOrigin: pubic crest and symphysisInse

6、rtion: xiphoid and 5th-7th costal cartilagesHas 3-4 tendinous intersections 腱劃linea semiluaris 半月線 Rectus abdominis 腹直肌PositionSimilar functions for above four pairs of musclesSupport and compress the abdominal visceraIncrease intra-abdominal pressure, aid in expulsive efforts-vomiting, coughing, sn

7、eezing, defecation, urination and childbirth.Depress ribs, assist in (the act of force(4)expiration.Flex, lateral flex, and rotate vertebral columnSimilar functions for above foSheath of rectus abdominis 腹直肌鞘Ant layerformed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of

8、 aponeurosis of obliquus internus abdominisPost layerFormed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominisAbsent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border na

9、med arcuate lineBelow this line rectus abdominis in contact with transverse fasciaSheath of rectus abdominis 腹直肌Linea alba 白線tendinous raphe between right and left recti from xiphoid to pubic symphysis.Linea alba 白線Inguinal region 腹股溝區(qū)Boundaries Inguinal ligament Lateral margin of rectus abdominisA

10、horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominisInguinal region 腹股溝區(qū)BoundariesDescent of testesSeven-week embryo showing the testis before its descent from the dorsal abdominal wallDescent of testesSeven-week emFetus at 28 week the testis passing through the

11、inguinal canalFetus at 28 week the testis paNewborn Newborn Inguinal canal 腹股溝管Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal lig.Inguinal canal 腹股溝管Position: oBoundariesAnt wallAponeurosis of obliquus externus abdominisObliquus internus abdominis (lateral third of

12、wall)BoundariesPost wallTransverse fascia Inguinal flax mediallyRoofarched lower fibers of obliquus internus and transversua abdominisFlooringuinal ligPost wallTwo openingsSuperficial inguinal ring 腹股溝淺環(huán)Deep inguinal ring 腹股溝深環(huán) defect in transverse fascia 1.5cm above midpoint of inguinal ligamentTwo

13、 openingsStructures passing through the inguinal canal Spermatic cord 精索 and ilioinguinal nerve髂腹股溝神經(jīng) in males Round ligament of uterus 子宮圓韌帶and ilioinguinal nerve髂腹股溝神經(jīng) in females Structures passing through theInguinal Triangle (of Hesselbach) 腹股溝三角 Boundaries Inguinal ligament inferiorlyLateral bo

14、rder of rectus abdominis medially Inferior epigastric artery laterallyInguinal Triangle (of HesselbaIndirect inguinal heinia and direcet inguinal heinia Indirect inguinal heinia and dSuperficial vessels and cutaneous nerves Arteries Superficial epigastric a.Superficial iliac circumflex a.Veins Thora

15、coepigastric v.Superficial epigastric v.Cutaneous nervesAnterior and lateral cutaneous n. of lower six thoracic Iliohypogastric n. (first lumb nerves)Superficial vessels and cutaneDeep vessels and nervesArteres Superior and inferior epigastric arterisLower posterior intercostal a.Subcostal a.Four lu

16、mbar a. Deep vessels and nervesArteresNerves Iliohypogastric n. 髂腹下神經(jīng)Arises from lubar plexusPasses forward in the interval between obliquus internus and tranversus abdominisPieces obliquus internus abdominis 2.5 cm medial to anterior superior iliac spinePieces aponeurosis of obliquus externus abdom

17、inisabout 2.5 cm above superficial inguinal ringIlioinguinal n. 髂腹股溝神經(jīng)Runs parallel with iliohypogastric n. at a lower levelEnters inguinal canal and emerges through superficial inguinal ringGenitofemoral n. 生殖股神經(jīng)Nerves Subcostal incision Muscle-splitting incisionTransverse incision Median or midlin

18、e incisionLeft paramedian incisionLayer ?Suprapubic incisionSubcostal incision Muscle-spliAbdomen 2山東大學(xué)醫(yī)學(xué)院 解剖教研室李振華Abdomen 2山東大學(xué)醫(yī)學(xué)院 解剖教研室Abdominal aorta 腹主動脈Continuation of thoracic aorta at aortic hiatus of diaphragm in front of T12 Terminates at lower border of L4 vertebra by dividing into right a

19、nd left common iliac arteries Abdominal aorta 腹主動脈ContinuatiParietal branchesInferior phrenic a. 膈下動脈(one pair)Lumbar a. 腰動脈(four pairs of arteries that supply the posterior abdominal wall)Median sacral a. 骶正中動脈Parietal branchesVisceral branches Paired branches Middle suprarenal artery 腎上腺中動脈Renal a

20、rtery 腎動脈Testicular (ovarian) artery 睪丸（卵巢）動脈Visceral branches Unpaired branches Celiac trunk 腹腔干 a short thick vessel that arises from the front of aorta, at the level of T12Superior mesenteric a. 腸系膜上動脈arises from the front of aorta, at the level of L2Inferior mesenteric a. 腸系膜下動脈 arises from the

21、front of aorta, at level of L3Unpaired branches Left gastric a.Common hepatic a.Splenic a.Gastroduodenal a.Proper hepatic a.Right gastric a.Left branchRight branchCystic a. Short gastric a. Left gastrioeploic a.Right gastroepiploic a.Superior pancreaticoduodenal a.Splemic branches Celiac trunk Left

22、gastric a.CommonSplenic aCeliac trunk Celiac trunk Superior mesenteric a. Inf. pancresticodudenal a.Jejunal and ileal a.Ileocolic a.Appendicular a.Right colic a.Middle colic a. Superior Mesenteric v.Superior Inf. pancresticodudenInferior mesenteric a.Left colic a.Sigmoid a.Superior rectal a. Inferio

23、r mesenteric v.Inferior mesenteric a.Left colColic marginal arteryColic marginal arteryRelations of abdominal aortaAnteriorly (from above downward) Pancreas Ascending part of duodenum Radix of mesenteryPosteriorly Upper four lumber vertebrae On its right Inferior vena cavaOn its left Left sympatheti

24、c trunkRelations of abdominal aortaVeins of abdomen and pelvisInternal iliac vein 髂內(nèi)靜脈Parietal tributaries: accompany with arteriesVisceral tributaries superior rectal veininferior mesenteric v.Rectal venous plexus inferior rectal veininternal iliac v.直腸靜脈叢 anal veininternal pudendal v. Vesical veno

25、us plexus 膀胱靜脈叢vesical v.Uterine venous plexus 子宮靜脈叢uterine v. Veins of abdomen and pelvisInt External iliac vein 髂外靜脈 accompany the arteryCommon iliac vein 髂總靜脈 formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4L5 by uniting each other to form inferior ve

26、na cava External iliac vein 髂外靜脈Inferior vena cava 下腔靜脈Formed by union of two common iliac veins anterior to and just to the right of L4L5Ascends on the right side of aorta, pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atriumConveys blood from the whole body below

27、 the diaphragm to the right atrium Inferior vena cava 下腔靜脈Formed Chief tributariesParietalPaired inferior phrenic v. 膈下靜脈paired lumbar v. 腰靜脈 (four)VisceralRight and left renal veins 左、右腎靜脈Right suprarenal vein 右腎上腺靜脈 (left drain into left renal vein) Right testicular or ovarian v右睪丸（卵巢）靜脈. (left dr

28、ain into left renal vein)Hepatic veins 肝靜脈: right, left and intermediateChief tributariesRelations of inferior vena cavaAnteriorly (cranially to caudally)LiverHead of pancreasHorizontal part of duodenumRight testicular (or ovarian) a.Radix of mesenteryPosteriorly Right crus of diaphragmUpper four lu

29、mber vertebraeLeft sympathetic trunkParietal branches of abdominal aorta On its right Psoas majorRight kidneyRight suprarenal glandOn its left Abdominal aortaRelations of inferior vena cavHepatic portal vein 肝門靜脈General featuresFormed behind the neck of pancreas by the union of superior mesenteric v

30、ein and splenic vein Ascends upwards and to the right, posterior to the first part of duodenum and then enters the lesser omentum to the porta hepatis, where it divides into right and left branches There are no functioning valves in hepatic portal system Drains blood from gastrointestinal tract from

31、 the lower end of oesophagus to the upper end of anal canal, pancreas, gall bladder, bile ducts and spleenHepatic portal vein 肝門靜脈GenerVariation and anomalies of hepatic portal veinVariation and anomalies Tributaries of hepatic portal vein 1. Superior mesenteric v. 腸系膜上靜脈2. Inferior mesenteric v. 腸系

32、膜下靜脈3. Splenic v. 脾靜脈4. Left gastric v. 胃左靜脈5. Right gastric v.胃右靜脈6. Cystic v. 膽囊靜脈7. Paraumbilical v. 附臍靜脈Tributaries of hepatic portal Portal-systemic anastomoses1. At the lower end of the oesophagus Hepatic portal vein left gastric vein esophageal venous plexus esophageal vein azygos vein superi

33、orvena cava2. At rectal venous plexus Hepatic portal vein splenic vein inferior mesenteric vein superior rectal vein rectal venous plexus inferior rectal and anal veins internal iliac vein inferior vena cava3. At periumbilical venous plexus Hepatic portal veinparaumbilical veinperiumbilical venous p

34、lexusthoracoepigastric and superior epigastric vein superiorvena cavasuperficial epigastric and inferior epigastric veins inferior vena cavaPortal-systemic anastomoses4. Portal-retroperitoneal anastomosis Between the retroperitoneal branches of the colic veins and the lumbar veins, pancreaticoduoden

35、al veins with the renal veins and the subcapsular veins of the liver with the phrenic veins twigs of colic veins (portal) anastomosing with systemic retroperitoneal veins 4. Portal-retroperitoneal anasThe lymphatic drainage of abdomenLymphatic drainage of abdominal wallTo axillary lymph node from re

36、gion above umbilicusTo superficial inguinal lymph node from region below umbilicusTo lumbar lymph node from post wall of abdomenThe lymphatic drainage of abdoLymphatic drainage of abdominal visceraLumbar lymph nodes 腰淋巴結(jié)Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cav

37、aReceive lymph from kidneys, suprarenal glands, testes, ovarirs, fundus of uterus, ovary, and common iliac nodesRight and left lumbar trunks formed by efferent vesselPaired visceradrain to the lumbar lymph nodesLymphatic drainage of abdominaCeliac lymph nodes 腹腔淋巴結(jié) situated around the celiac trunk S

38、uperior mesenteric lymph node 腸系膜上淋巴結(jié) situated around superior mesenteric a. Inferior mesenteric lymph node 腸系膜下淋巴結(jié) situated around inferior mesenteric a. Intestinal trunk 腹腔干 formed by efferent vessel of celiac, superior and inferior lymph nodesCeliac lymph nodes Thoracic duct 胸導(dǎo)管Begins in front of

39、 L1 as a dilated sac, the cisterna chyli, which formed by joining of left and right lumbar trunks and intestinal trunkEnter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column, between thoracic aorta and azygos veinTravels upwa

40、rd, veering to the left at the level of T5At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angleJust before termination, it receives the left jugular, subclavian and bronchomediastinal trunksDrains lymph from lower limbs, pelvic cavity, abdominal

41、cavity, left side of thorax, and left side of the head, neck and left upper limbThoracic duct 胸導(dǎo)管Spleen 脾Location: lies in the left hypochondriac region (between stomach and diaphragm) deep to the 9th to 11th rib, its long axis corresponds roughly to the 10th ribShapereddish in colourSpleen 脾Locatio

42、n: lies in the Two surfaces Diaphragmatic: smooth, convexVisceral: concave, hilum of spleenTwo extremities AnteriorwiderPosteriorrounderTwo border Superiorhas 2-3 splenic notch 脾切跡, which serve as a landmark on palpation when it is enlarge; normally it is not palpableInferiorrounderFunctions: the sp

43、leen is considered to be important in:Formation of lymphocytes and monocytePhagocytosis of bacteria, inert particles and white blood cells and plateletsDestroying effete or abnormal red blood cellsMaking antibodiesTwo surfaces Ralationships of spleenDiaphragmatic surfacediaphragmVisceral surfaceAnte

44、riorlyfundus of stomachPosteriorlyleft suprarenal gland and kidneyInferiorlytail of pancreas and left colic flexure Ralationships of spleenNervers of abdomen Lumbar plexus 腰叢Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4Position: lies within substance of psoas majo

45、rNervers of abdomen Lumbar plexBranches Iliohypogastric n. 髂腹下神經(jīng)Supplies lower part of anterior abdominal wallIlioinguinal n. 髂腹股溝神經(jīng)Passes through inguinal canal to supply skin of the groin and scrotum Lateral femoral cutaneous 股外側(cè)皮神經(jīng)Femoral n. 股神經(jīng)Obturator n. 閉孔神經(jīng)Genitofemoral n. 生殖股神經(jīng)Branches Lumb

46、ar sympathetic trunk 腰交感干Made up of paired chains with four to five lumbar ganglia anterolateral to vertebral columnEnters abdomen via the diaphragm and as a continuation of he thoracic partPasses inferiorly behind common iliac vessels and terminations by joining to form unpaired ganglion impar, ant

47、erior to sacrumLumbar sympathetic trunk 腰交感干MAbdomen 3山東大學(xué)醫(yī)學(xué)院 解剖教研室李振華Abdomen 3山東大學(xué)醫(yī)學(xué)院 解剖教研室Relationships of abdominal viscera First layerlive, gallbladder, stomach Second layerduodenum, pancreas, spleenThird layersuprarenal gland, kidney, ureter, inferior vena cava, abdominal aorta, nerves and lymp

48、haticsRelationships of abdominal vis Relationships of the stomachAnterior:Live (right part) Diaphragm (left upper part) Anterior abdominal wall (left lower part) Posteriorseparated by peritonum of lesser sac from the following (“stumach-bed”) Pancreas Left suprarenal glandLeft kidneySpleen Transvers

49、e colon and transvers mesoclon Relationships of the stomachAArteries of stomachLeft and right gastric arteries arise from celiac trunk and proper hepatic artery, repectively. These two vessels run in lesser omentum along lesser curvature , and anastomose end-to-end.Arteries of stomachRight and left

50、gastroepiploic arteries arise from the gastroduodenal and splenic artery, repectively. These two vessels pass into the greater omentum, run parallel to the greater curvature, and anastomose end-to-end.Short gastric arteries, branches of splenic artery, course through the gastrosplenic ligament and s

51、upply the fundus of stomach. Posterior gastric artery (72%) arise from the splenic artery, course through the gastrophrenic ligament and supply the posterior wall of fundus of stomach.Right and left gastroepiploic Venous drainageRight and left gastric veins empty directly into hepatic portal vein.Le

52、ft gastroepiploic and short gastric veins drain into hepatic portal vein via the splenic vein.Right gastroepiploic vein join either superior mesenteric vein.Venous drainageLymphatics of stomach Right and left gastric ln. lie along the same vessels and finally to the celiac ln.Right and left gastroom

53、ental ln. lie along the same vessels, the former drain into subpyloric ln., the latter drain into splinic ln.Supra- and subpyloric ln. receive lymphatics from pyloric part and finally to the celiac ln.Splenic ln. receive lymphatics from fundus and left third of stomach, and finally to the celiac ln.

54、 Lymphatics of stomach Nerve supplyParasympathetic innervation by anterior (left) and posterior (right) vagal trunksThe anterior trunk divides into anterior gastric and hepatic branchesThe posterior trunk divides into posterior gastric and celiac branchesThe anterior and posterior gastric branches d

55、escend on the anterior and posterior surfaces of the stomach as a rule about 1 to 2 cm from the lesser curvature and parallel to it in the lesser omentum as far as thr pyloric antrum to fan out into branches called “crows foot” to supply the pyloric partSympathetic innervationMainly from celiac gang

56、liaAffent and effent fibers derives from thoracic segments (T5 L1Nerve supplyThe duodenumRelationships of superior part AnteriorlyQuadrate lobe of liveGallbladderPosteriorlyCommom bile duct Gastroduodenal a.Hepatic portal v.Inferior vena cavaSuperioely Omental foramenInferiorly Head of pancreas The

57、duodenumRelationships of Relationships of descending partAnteriorlyLive Transverse colon and mesocolonLoops of small intestine Posteriorly Right renal hilum and ureterRight renal vesselsMediallyHead of pancreasCommon bile duct and pancreatic ductLaterally Right colic flexureRelationships of descendi

58、ng pRelationships of horizontal partSuperiorlyHead of pancreasInferiorly Loops of small intestine AnteriorlyRadix of mesenterySuperior mesenteric a. and v. PosteriorlyRight ureterInferior vena cavaAbdominal aorta Relationships of horizontal paRelationships of ascending partRight Head of pancreas and

59、 abdominal aortaLeft Left kidney and ureterRelationships of ascending parRelationships of liverDiaphragmatic surfaceseparated by diaphragm from the following Right costodiaphramatic recess and lungCardiac baseVisceral surfaceLeft lobe is related to the stomach and abdominal part of esophagus Right l

60、obe is related to the right colic flexure anteroly, gallbladder and superior duodenal flexure medially, right kidney, superarenal gland posteriorlyRelationships of liverDiaphragBlood supply Arteries Superior pancreaticoduodenal a.Inferior pancreaticoduodenal a.Veinsfollow arteries, draining directly