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Abdominal Wall & Stomach

Abdominal Wall & Stomach. Dr. Nimir Dr. Safaa. Objectives. Define the abdominal wall . Enlist the layers .. Give its blood and nerve supply. Applied anatomy Discuss stomach in terms of its parts and musculature. Enlist the peritoneal relations of the stomach.

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Abdominal Wall & Stomach

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  1. Abdominal Wall & Stomach Dr. Nimir Dr. Safaa

  2. Objectives Define the abdominal wall. Enlist the layers.. Give its blood and nerve supply. Applied anatomy Discuss stomach in terms of its parts and musculature. Enlist the peritoneal relations of the stomach. Enlist the structures forming stomach bed. Discuss the blood supply of the stomach.

  3. Abdominal wall divided into:- Anteriolateral abdominal wall • Anterior wall • Right lateral wall (Right Flank) • Left lateral wall (Left Flank) Posterior abdominal wall

  4. Anterolateral Abdominal Wall This extended from the thoracic cage to the pelvis and bounded : • Superiorly • 7th through 10th costal cartilages and and xiphoid process • Inferiorly • Inguinal ligaments and the pelvic bones. The wall consists of skin, subcutaneous tissues (fat), muscles, deep fascia and parietal peritoneum.

  5. Antrolateral Abdominal WallFascia & Subcutaneous Tissues The subcutaneous tissues over most of the wall consists of layer of connective tissues that contains a variable amount of fat. In the inferior part of the wall , the subcutaneous tissue is composed of two layers • Fatty superficial layer (Camper’s fascia) • Membranous deep layer (Scarpa’s fascia)

  6. Antrolateral Abdominal WallMuscles • 3 Flat Muscles with strong sheet like aponeuroses • External Oblique • Internal Oblique • Transversus Abdominus • 2 Vertical Muscles • Rectus Abdomius • Pyramidalis

  7. AnterolateralAbdominal WallNerves • T7 – T11 Thoracoabdominal Nerves • T12 Sub-costal nerve • L1 ilio-hypogastric Nerve ilioinguinal Nerves

  8. Antrolateral Abdominal WallArteries • Internal Thoracic Artery • Superior Epigastric Artery • External Iliac Artery • Inferior Epigastric Artery • Deep Circumflex Iliac Artery • Femoral Artery • SuperfecialEpigastric Artery • SuperfecialCircumflex Artery

  9. Applied Anatomy • Abdomen is divided into 9 regions via four planes: • Two horizontal [sub-costal (10th) and trans tubercules plane] (L5). • Two vertical (midclavicular planes). • They help in localization of abdominal signs and symptoms

  10. The nine abdominal regions:-

  11. Anterior Abdominal WallFunctions • Form strong expandable support. • Protect the abdominal viscera from injury such as low blow in boxing • Compress the abdominal content • Helps to maintain or increase the intraabdominal pressure. • Move the trunk and help to maintain posture.

  12. Protuberance of the abdomen. The five common causes (5F) • Fat, Faeces, Fetus, Flatus And Fluid • Abdominal Hernias • Anteriolateral abdominal wall may be the site of hernias • Inguinal, umbilical and epigastric regions

  13. Posterior Abdominal Wall • Lumbar vertebrae and IV discs. • Muscles • Psoas, quadratus lumborum, iliacus, transverse, abdominal wall oblique muscles. • Lumbar plexus • Ventral rami of lumbar spinal nerves. • Fascia • Diaphragm • Contributing to the superior part of the posterior wall • Fat, nerves, vessels (IVC, aorta) and lymph nodes.

  14. Posterior Abdominal WallFascia Between the parital peritoneum and the muscles • The psoas fascia or psoas sheath. • The quadratus lumborum fascia. • The thoracolumbar fascia.

  15. Posterior Abdominal WallMuscles Three paired muscles • Psoas major • Iliacus • Quadratus Lumborum

  16. Posterior Abdominal WallNerves The sub costal nerves The lumbar nerves The lumbar plexus of nerves branchus are: (a)The obturator nerves (L2 – L4) (b)The femoral nerves (L2 – through L4) (c)Ilio inguinal and iliohypogastric nerves (L1) (d) Gentio femoral (L1 – L2) (e) Lateral femoral cutaneous nerves (L2 – L3)

  17. Posterior Abdominal WallBlood Vessels • Aorta and its branches • IVC and its tributeries

  18. Applied Anatomy Posterior abdominal pain: Ilio-psoas has relationship to kidney, ureters, caecum, appendix, colon, pancreas….etc. When any of these structures is diseased movement of the iliopsoas usually causes pain. When intra abdominal inflammation is suspected the IlioPsoas Test performed by moving ileopsoas muscle and if positive it causes pain.

  19. Psoas Abscess Hematogenous spread to the lumbar vertebrae may form an abscess which may spread from the vertebrae into the Psoas sheath producing a Psoas abscess.

  20. Stomach

  21. The muscular wall The outer longitudinal layer The intermediate circular layer The innermost oblique layer

  22. Stomach Musculature

  23. mucous membrane rugae

  24. Stomach

  25. Stomach bed:- • Transverse colon • Transverse mesocolon • Pancreas • Spleen& splenic artery • Left kidney • Left suprarenal • Left crus of the diaphragm

  26. Arterial supply of the stomach:-

  27. Venous drainage:-

  28. Arteries of the stomach left and right gastric, left and right gastroepiploic, and the short gastric arteries.

  29. Veins of the stomach left and right gastric veins --> portal vein left gastroepiploic and the short gastric veins --> splenic vein The right gastroepiploic vein --> superior mesenteric vein.

  30. Thank you

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