Transcript Document

Abdomen 4
2.7 Duodenum and pancreas
2.8 Kidneys, suprarenal glands and ureters
2.9 Posterior abdominal wall and diaphragm
Albert van Schoor
GNK 288 (SA4 Anatomy dissection)
2.7 Duodenum and pancreas
2.7.1 Surface anatomy
2.7.1 Structure
2.7.3 Blood supply, nerve supply
and lymph drainage
2.7.1 Surface anatomy
• Review the surface anatomy of the
duodenum and pancreas
• Name the vertebral heights of the various
parts of the pancreas
2.7.1 Surface Anatomy
1st part
• Approx. 5 cm
long
• Anterolateral
of body of L1
• On the
transpyloric
line
2.7.1 Surface Anatomy
2nd part
• Approx. 7-10
cm long
• Descends
along the right
sides of L1-L3
2.7.1 Surface Anatomy
3rd part
• Approx. 6-8
cm long
• Horisontal
• Crosses the
body of L3
2.7.1 Surface Anatomy
4th part
• Approx. 5cm
cm long
• Begins at the
left of L3
• Rises superior
as far as the
superior
border of L2
2.7.1 Surface Anatomy
L1
L2
L3
L1
L2
T12
2.7.2 Structure
• Identify and briefly describe the four parts
of the duodenum and the structures
opening into it
2.7.2 Structure
1st part
• 1st 5cm from
gastroduodenal
junction
• Anterior:
– Liver
– Gallbladder
• Posterior:
– Ant. Border of
omental foramen
(gastroduodenal
artery)
2.7.2 Structure
•
•
•
•
2nd part
7-10cm long
Vertical
Curves around
head of pancreas
Anterior:
– Transverse colon
• Posterior:
– Right kidney and
ureter
• Posteromedial:
– Major and minor
duodenal papillae
2.7.2 Structure
3rd part
• Horisontal 6-8cm
• Anterior:
– Superior
mesenteric artery
– Mesentry of small
intestines
• Posterior:
– IVC
– Aorta
– L3
• Superior:
– Head of pancreas
2.7.2 Structure
4th part
• Runs vertical for
2.5 - 5cm to
duodenojejenal
junction
• Suspensory
ligament of
duodenum (Lig. of
Treitz) extend from
right crus of
diaphragm
• Suspends
duedenojejenal
junction
2.7.2 Structure
• Identify and schematically illustrate the different
parts (regions) and duct system of the pancreas
• Identify and list the general and peritoneal
relations of the four parts of the duodenum
• Identify and briefly discuss the relations of the
pancreas to the spleen, duodenum, stomach and
transverse colon and peritoneum
• Identify the root of the transverse colon
2.7.2 Structure
Accessory
pancreatic
duct of
Santorini
Major
pancreatic
duct of
Wirsung
2.7.2 Structure
• Identify and briefly discuss the relations of
the pancreas to the spleen, duodenum,
stomach and transverse colon and
peritoneum
• Identify the root of the transverse colon
2.7.2 Structure
• Superior:
– Splenic artery
– Common hepatic
artery
• Posterior:
– IVC
– Aorta
– Sup. mesenteric
vessels
– Crurae of diaphragm
– Coeliac plexus
– Left kidney
• Anterior:
– Stomach
– Transverse
mesocolon
– Omental bursa
2.7.3 Blood supply and lymph
drainage
• Identify, trace and list the arterial supply
and venous drainage of the duodenum
and pancreas
• Give a broad overview of the major
lymph node groups into which the upper
abdominal organs drain
2.7.3 Blood & Lymph
2.7.3 Blood & Lymph
• Veins follows the arteries
• Drains into portal vein either directly or
indirectly through:
– Superior mesenteric vein
– Splenic vein
2.8 Kidneys, suprarenal glands and
ureters
2.8.1 Surface anatomy
2.8.2 Structure
2.8.3 Blood supply, nerve supply
and lymph drainage
2.8.4 Radiographic anatomy
2.8.1 Surface anatomy
• Review the surface anatomy of the
kidneys
• Identify the bony relations of the kidneys
and ureters
2.8.1 Surface Anatomy
• Left:
L1
L2
– 5cm from
median plane
– Transpyloric
line through
hilum of kidney
• Right
– Transpyloric
line through
superior pole
of kidney
– Inferior pole
2.5cm from
ileac crest
2.8.1 Surface Anatomy
T11
T11
T12
Psoas Major
Quadratus Lumborum
Transverse Abdominis
T12
2.8.2 Structure
• Annotate a coronal section of the kidneys as
follows: hilus, pelvis, calices, pyramids and
columns
• Identify and name the general and
peritoneal relationships of both kidneys
• Identify and name the abdominal course
and relationships of both ureters in both
sexes
2.8.2 Structure
• Identify both suprarenal glands
• Compare the relative position of the two
kidneys and suprarenal glands
• Distinguish the three parts of the ureter and
list where a kidney stone might obstruct it
2.8.2 Structure
2.8.2 Structure
• Approximately 25cm long
• Urine moves by means of peristaltic movements
• 3 Components:
– Abdominal: adjacent to transverse processes of lumbar
vertebrae L2-L5
– Pelvic: enters true pelvis, continues medial, over
internal iliac artery, and anteromedial towards bladder
– Intramural: short part between 2 layers of bladder wall.
Serves as a mechanical valve to prevent reflux of urine
2.8.2 Structure
• Potential constrictions:
– Renal pelvis
– Where ureter crosses
the internal iliac artery
– Between the 2 muscle
layers of the bladder
wall
2.8.3 Blood supply, nerve
supply and lymph drainage
• Trace, identify and compare the course and
relations of both renal arteries and veins
• Identify, trace and name the arterial supply
and venous drainage of both suprarenal
glands
2.8.3 Blood & nerve supply, Lymph drainage
2.8.4 Radiographic anatomy
• Identify the following on a urogram (or IVP):
–
–
–
–
–
–
Kidneys
ureters,
bladder,
major and minor calyces,
pelvis of kidney, and
relation of the ureters to the transverse processes of
the lumbar vertebrae
www.up.ac.za/academic/medicine/anatomy/current/sa4/week01e.html#radio
2.9 Posterior abdominal wall and
diaphragm
2.9.1 Abdominal aorta
2.9.2 Abdominal inferior vena cava
2.9.3 Lymph drainage
2.9.4 Nerve structures
2.9.5 Fascia
2.9.6 Muscles
2.9.7 Diaphragm
2.9.8 Osteology
2.9.1 Abdominal aorta
• Identify the course, relationships and
branches of the abdominal aorta
2.9.1 Abdominal aorta
• 3 unpaired to viscera
(anterior)
– Coeliac trunk
– Sup. mesenteric
– Inf. mesenteric
• 3 paired to viscera
(lateral)
– Suprarenal
– Renal
– Gonadal
• 5 paired (lateral)
– Inferior phrenic
– 4 pairs of lumbar
• 2 paired terminal
branches
– Common iliac
– Median sacral
2.9.2 Abdominal inferior vena
cava
• Briefly discuss and identify the course,
relations and tributaries of the inferior
vena cava
• Identify the different drainage of the left
and right gonadal veins
2.9.3 Lymph drainage
• Give a broad overview of the lymph
drainage of the abdomen
2.9.4 Nerve structures
• Identify and briefly describe the
sympathetic trunk and where possible
the plexuses
2.9.4 Nerve structures
• 2 parallel nerve cords
• Extending on either
side of the vertebral
column from the base
of the skull to the
coccyx.
• 2 sympathetic trunks
come together
anterior to the coccyx
to form the ganglion
impar.
2.9.4 Nerve structures
• Identify and discuss the distribution and
root values of the following nerves of
the lumbar plexus:
–
–
–
–
–
–
–
Subcostal,
iliohypogastric,
ilioinguinal,
lateral cutaneous nerve of the thigh,
genitofemoral,
femoral and
obturator nerves
• Give an overview of the autonomic
nerve supply of the abdomen
2.9.4 Nerve structures
Autonomic
Sympathetic
• Splanchnic nerves
– Thoracic (Coeliac plexus)
– Lumbar (Intermesenteric /
aortic & superior
hypogastric plexus)
– Sacral (Inferior hypogastric
plexus)
– Pelvic* (Inferior hypogastric
plexus)
* Both sympathetic and parasympathetic
Paraympathetic
• Vagus nerve (X) ~ cranial
outflow
– Foregut & midgut
• S2-S4 ~ abdominal
outflow
– Hindgut
• Intermesenteric / aortic
plexus
• Superior & inferior
mesenteric plexuses
• Superior & inferior
hypogastric plexuses
2.9.5 Fascia
• Identify the layers of the thoracolumbar
fascia
• Identify the psoas and iliac fascia
2.9.6 Muscles
• Identify and briefly discuss the major
attachments, relationships to organs
and nerves, as well as the nerve supply
of the following muscles:
– psoas major,
– iliacus and
– quadratus lumborum
2.9.6 Muscles
Muscle
Origin
Insertion
Psoas
major
Lateral surface of bodies
and intervertebral discs of
T12 and L1 to L5,
transverse processes of
the lumbar vertebrae
Lesser
trochanter of
the femur
Quadratus
Lumborum
Iliacus
Transverse process of L5,
iliolumbar ligament, and
iliac crest
Upper two-thirds of iliac
fossa, anterior sacro-iliac
and iliolumbar ligaments,
and upper lateral surface
of sacrum
Innervation
Anterior rami of
L1 to L3
Transverse
processes of
L1-L4 and
inferior border
of rib 12
Anterior rami of
T12 and L1 to L4
Lesser
trochanter of
femur
Femoral nerve
(L2 - L4)
2.9.7 Diaphragm
• Review the surface anatomy of the diaphragm
• Identify and name it's attachments, blood
supply and nerve supply
2.9.7 Diaphragm
1a) Vertebral ~
crura
• Right Crus
– L1-L3
• Left Crus
– L1-L2
2.9.7 Diaphragm
1b) Vertebral ~
fibrous arches
• Median
arcuate lig
– aorta
• Medial
arcuate lig
– Psoas major
• Lateral
arcuate lig
– Quadratus
lumborum
2.9.7 Diaphragm
2) Costal
• Ribs 7-12
3) Sternal
• 2 small
attachments
to
xiphisternum
2.9.7 Diaphragm
• Innervation
– Motor supply ~ phrenic nerve
• Blood supply ~ superior
– Superior phrenic artery (thoracic aorta)
– Musculophrenic and pericardiophrenic
arteries(internal thoracic artery)
• Blood supply ~ inferior
– Inferior phrenic artery (abdominal aorta)
2.9.7 Diaphragm
• List it's superior and inferior relations on the
left and right
• Identify and name the orifices of the
diaphragm with their vertebral heights and
contents and the structures penetrating the
diaphragm separately
2.9.7 Diaphragm
T8
T10
T12
2.9.7 Diaphragm
• Identify and name the arcuate ligaments of
the diaphragm and the structures related
posterior to them
• Identify and name the crura of the diaphragm
in relation to the oesophageal hiatus
2.9.8 Osteology
• Identify and briefly discuss the bony elements
of the posterior abdominal wall