The Infracolic Compartment

Ⅰ. Location

It lies between the transverse colon with its mesocolon and the superior aperture of the lesser pelvis.

Ⅱ. Contents

the jejunum, ileum, vermiform appendix, colon and other viscera.

Ⅲ. The vermiform appendix

The features

--- a narrow, worm-shaped, blind tube.

---about 5~7cm long.

---diameter is 0.5~1.0cm.

---intraperitoneal organ, has a triangular mesentery.

The position

---the root joins with the posteromedial wall of the cecum.

---the 3 colic bands focus at the root.

---the projection of the root of the vermiform appendix *The McBurngy’s point at the junction of the lateral and middle thirds of the line between the right superior iliac spine and the umbilicus.

---it is variable in position A. the pelvic position: 41.3%; B. the retrocecoal or retrocolic position:29.4%; C. the subcecal position:17.4%; D. the pre-ileal position: 7.4%; E. the post-ileal position:4.4%.

(III) The appendix artery and vein

I) the artery arises from the ileocolic a. and usually is single.

II) the vein drains into the hepatic portal vein.

the appendicular v. the ileocolic v.

the superior mesenteric v. hepatic portal v.

appendicitis the bacterial emboli enter the liver by the course and lead to hepatic abscess.

The blood supply of colon

----

the superior and inferior mesenteric arteries

Ⅳ. The hepatic portal vein

---a shorter and thicker venous trunk.

---about 6~8cm long and 1~1.2 cm in diameter ---drains the venous blood from the single viscera(except the liver) in the abdominal cavity.

---is the functional blood vessel of the liver.

(Ⅰ) Formation It is formed by the union of the superior mesenteric and splenic veins behind the neck of the pancreas.

three types: type 1 (51.2%) portal v. type 2(15.3%) splenic v.

inf. mesenteric v.

sup. mesenteric v.

type 3 (32.7%)

(Ⅱ)Relationship The hepatic portal vein ascends behind the head of the pancreas and the sup. part of the duodenum, towards the right and upwards,enters the hepatoduodenal ligament.It ascends in the ligament and divides into right and left branches at the porta hepatis. The common bile duct is right and anterior toit and the proper hepatic artery is left and anterior.

(Ⅲ) Tributaries splenic vein superior mesenteric vein inferior mesenteric vein left gastric vein right gastric vein systic vein paraumbilical vein

(Ⅳ) Communications between hepatic portal and systemic veins 1. Esophageal venous plexus 2. Rectal venous plexus 3. Paraumbilical venous plexus

The retroperitoneal space

Ⅰ. Location The space lies between the parietal peritoneum and the fascia and musculature of the posterior abdominal wall.

It extends superiorly from the diaphragm, and inferiorly to the sacral promontory and the pelvis inlet.

Ⅱ. Communication superiorly continuous with the posterior mediastinum inferiorly continuous with pelvic retroperitoneal space.

Ⅲ. Contents

kidneys, suprarenal glands, abdoinal part of the ureters, pancreas, duodenum, blood vessels, lymph nodes, and nerves.

Ⅳ. The kidneys

1. Position The kidneys lie on each side of the lumbar part of the vertebral column. The left kidney is about 1.5cm higher than the right one.

Upper pole Lower pole L kidney T11th L2nd R Kidney T12th L3nd

The 12th rib crosses obliquely the upper third of the posterior surface of the right kidney; but the middle part of the left one.

the renal angle: the lateral border of the erector spinae crosses 12 th rib. The hilum of the kidneys is at the angle.

The projection of the kidneys on the each side of the posterior surface of the body, 2 vertical lines and 2 horizontal line form a quadrilateral area, in which the kidney lies.

medial vertical line 2.5cm apart from the post. median line lateral vertical line 7.5cm

Upper horizontal line (passing the spine of T11th) Lower horizontal line (passing the spine of the L3rd)

2.Relation

The upper pole covered by the suprarenal gland.

relation upper Ant. middle Post.

lower L kidney R kidney

stomach,spleen tail of pancreas right lobe of liver descending part of the duodenum colis of jejunum Left colic flexure right colic flexure diaphragm above,psoas major,qua dratus lumborum,transverse abdominis

3. The hilum, sinus and pedicle of the kidney The hilum at the medial border, it’s the entrance of the sinus.

The sinus a hollow recess in the kidney.

The pedicle The structures, which enter or leave the hilum, form the pedicle. It contains mainly the renal artery,renal vein and pelvis.

arrangement of the pedicle from anterior to posterior is: V, A and P.

from above downwards is: A,V and P.

4. Renal capsule From outside inwards,the are renal fascia, adipose capsule and fibrous capsule.

1) The renal fascia anterior layer 2 layers posterior layer 2) The adipose capsule supports and protects the kidney 3) The fibrous capsule