腹部解剖图谱_英文课件.pdf

Abdominal wall Anterior wallLayers(from superficial to deep)Skin Superficial fascia Anterolateral muscles Transversalis fascia腹横筋膜 Extraperitoneal fascia 腹膜下筋膜 Parietal peritoneum 壁腹膜b IPHISuperficial fascia divisions below umbilicus Superficial fatty layer(Campers)Membranous layer(Scarpas)Muscles of abdomenAnterolateral group Obliquus externus absominis腹外斜肌 Oblequus enternus abdominis腹内斜肌 Transversusabdominis腹横肌 Rectus abdominis 腹 直肌Posterior group Quadiatus lumborum 腰方肌 Psoas major 腰大肌Obliquus externus absominis 膜外斜肌General direction of fibers:downward,forward and medially(run down and inward)Structures Inguinal ligament 腹触沟韧带 Lacunar ligament 腔隙韧带 Superficial inguinal ring 腹股沟浅环-triangularshaped defect in aponeurosis of obliquus externus abdominis above pubic tubercleObliquus internus abdominis 膜 内斜肌 Deep to obliquus externus abdominis General direction of fibres:upwards,forwards and mediallyTrans ver seis abdominis 膜横肌 Deep to obliquus internus Inguinal falx 腹股沟镰：arch over spermatic cord,inserted with transverses abdominis fiber into medial part ofpecten of pubis Cremaster 提睾肌：around the spermatic cord and testisRectus abdominis 底直肌 Position:lie on to either of midline Origin:pubic crest and symphysis Insertion:xiphoid and 5th-7th costal cartilages Has 3-4 tendinous intersections 腱划 linea semiluaris 半月线Similar functions for above four pairs of muscles Support and compress the abdominal viscera Increase intra-abdominal pressure,aid in expulsive efforts-vomiting,coughing,sneezing,defecation,urination and childbirth.Depress ribs,assist in(the act of force(4)expiration.Flex,lateral flex,and rotate vertebral columnSheath of rectus abdominis 底直肌鞘Ant layerformed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominisPost layerFormed by fusion of posteriori 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 named arcuate lineBelow this line rectus abdominis in contact with transverse fasciaInternal obliqueExternal obliqueTransversus abdominis Traniversahs foscnLinea alba 白线tendinous raphe between right and left recti from xiphoid to pubic symphysis.Inguinal region 腹股沟区Boundaries Inguinal ligament Lateral margin of rectus abdominis A horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominisDescent of testesSeven-week embryo showing the testis before its descent from the dorsal abdominal wallFetus at 28 week the testis passing through the inguinal canal Spermatic cordNewbornInguinal canal 腹股 沟管Position:oblique passage,4cm long,located 1.5cm above medial half of inguinal lig.Boundaries Ant wall Aponeurosis of obliquus externus abdominis Obliquus internus abdominis(lateral third of wall).Post wall Transverse fascia Inguinal flax medially Roofarched lower fibers of obliquus internus and transversua abdominis Flooringuinal lig.I Two openings Superficial inguinal ring 腹股 沟浅环 Deep inguinal ring 腹股沟深环 一 defect in transverse fascia 1.5cm above midpoint of inguinal ligamentStructures passing through the inguinal canal Spermatic cord 精索 and ilioinguinal nerve骼腹股沟神经 in males Round ligament of uterus 子宫圆韧带and ilioinguinal nerve骼腹股 沟神经in femalesInguinal Triangle(of Hesselbach)腹股沟三角Boundaries Inguinal ligament inferiorly Lateral border of rectus abdominis medially Inferior epigastric artery laterallyIndirect inguinal heinia and direcet inguinal heiniaSuperficial vessels and cutaneous nerves Arteries Superficial epigastric a.Superficial iliac circumflex a.Veins Thoracoepigastric v.Superficial epigastric v.Cutaneous nerves Anterior and lateral cutaneous n.of lower six thoracic Iliohypogastric n.(first lumb nerves)Deep vessels and nervesArteres Superior and inferior epigastric arteris Lower posterior intercostal a.Subcostal a.Four lumbar a.Nerves Iliohypogastric n.骼腹下神经 Arises from lubar plexus Passes forward in the interval between obliquus internus and tranversus abdominis Pieces obliquus internus abdominis 2.5 cm medial to anterior superior iliac spine Pieces aponeurosis of obliquus externus abdominisabout 2.5 cm above superficial inguinal ring Ilioinguinal n.骼腹股沟神经 Runs parallel with iliohypogastric n.at a lower level Enters inguinal canal and emerges through superficial inguinal ring Genitofemoral n.生殖股神经Layer?Subcostal incisionTransverse incisionMuscle-splittingMedian or midline incisionLeft paramedian incisionSuprapubic incisionAbdomen 2山东大学医学院解剖教研室 李振华Abdominal aorta 膜主动脉 Continuation of thoracic aorta at aortic hiatus of diaphragm in front of T12 Terminates at lower border of L4 vertebra by dividing into right and left common iliac arteriesParietal branches Inferior phrenic a.膈 下动脉(one pair)Lumbar a.腰动脉(four pairs of arteries that supply the posterior abdominal wall)Median sacral a.B 正中动脉Visceral branches Paired branches Middle suprarenal artery肾上腺中动脉 Renal artery 肾动脉 Testicular(ovarian)artery睾丸(卵巢)动脉 Unpaired branches Celiac trunk 腹腔干a short thick vessel that arises from the front of aorta,at the level of T12 Superior mesenteric a.肠素膜上动脉一arises from the front of aorta,at the level of L2 Inferior mesenteric a.肠 系膜下动脉一arises from the front of aorta,at level of L3Celiac trunkCystic a.Right gastric a.Gastroduodenal a.Left branchRight branchShort gastric a.Proper hepatic a.Common hepatic a.Left gastric a.Left gastrioeploic a.Right gastroepiploic a.Splenic a.Splemic branchesSyperiof-pancFeatiGGduodenal a.Celiac trunkr-一Right colic a.Ileocolic a.Middle colic a.Appendicular a.L Superior Mesenteric v.Superior mesenteric a.Jejunal and ileal a.Left colic a.Sigmoid a.Superior rectal a.Inferior mesenteric v.Inferior mesenteric a.Colic marginal arteryRelations of abdominal aorta Anteriorly(from above downward)Pancreas Ascending part of duodenum Radix of mesentery Posteriorly Upper four lumber vertebrae On its right Inferior vena cava On its left Left sympathetic trunkVeins of abdomen and pelvisInternal iliac vein 骼内静脉 Parietal tributaries:accompany with arteries Visceral tributaries一superior rectal veininferior mesenteric v.Rectal venous plexus J 一inferior rectal vein一internal iliac v.直肠静脉丛 一anal veininternal pudendal v.Vesical venous plexus 膀胱静脉丛一vesical v.Uterine venous plexus 子宫静脉丛一uterine v.External iliac vein夕卜静脉一 accompanythe arteryCommon iliac vein总静脉一 formed byunion of internal andexternal iliac veins in front of sacroiliac joint,end upon L4L5 by uniting each other to form inferior vena cavaInferior vena cava 下腔静脉 Formed by union of two common iliac veins anterior to and just to the right of L4L5 Ascends on the right side of aorta,pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atrium Conveys blood from the whole body below the diaphragm to the right atriumChief tributaries Parietal Paired inferior phrenic v.膈下静脉 paired lumbar v.腰静脉(four)Visceral Right and left renal veins 左、右肾静脉 Right suprarenal vein 右肾上腺静脉(left drain into left renal vein)Right testicular or ovarian v 右睾丸(卵巢)静脉.(left drain into left renal vein)Hepatic veins 肝静脉：right,left and intermediateRelations of inferior vena cava Anteriorly(cranially to caudally)Liver Head of pancreas“Horizontal part of duodenum、Right testicular(or ovarian)a.Radix of mesentery Posteriorly Right crus of diaphragm Upper four lumber vertebrae Left sympathetic trunk Parietal branches of abdominal aorta p On its right L Psoas major 1 Right kidney Right suprarenal gland On its left Abdominal aortaHepatic portal vein 所 门静脉General features Formed behind the neck of pancreas by the union of superior mesenteric vein 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 the lower end of oesophagus to the upper end of anal canal,pancreas,gall bladder,bile ducts and spleenVariation and anomalies of hepatic portal veinTributaries of hepatic portal vein1.Superior mesenteric v.肠系膜上静脉2.Inferior mesenteric v.肠系膜下静脉3.Splenic v.脾静脉4.Left gastric v.胃左静脉5.Right gastric v.胃右静脉6.Cystic v.胆囊静脉7.Paraumbilical v.附脐静脉Portal-systemic anastomoses1.At the lower end of the oesophagusHepatic portal vein left gastric vein esophageal venous plexus 一 esophageal vein azygos vein superiorvena cava2.At rectal venous plexusHepatic portal vein splenic vein inferior mesenteric vein superior rectal vein rectal venous plexus-inferior rectal and anal veins 一 internal iliac vein 一 inferior vena cava3.At periumbilical venous plexusHepatic portal veinparaumbilical vein一periumbilical venous plexus-thoracoepigastric and superior epigastric vein 一superiorvena cava superficial epigastric and inferior epigastric veins inferior vena cava4.Portal-retroperitoneal anastomosisBetween the retroperitoneal branches of the colic veins and the lumbar veins,pancreaticoduodenal 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 veinsThe lymphatic drainage of abdomenLymphatic drainage of abdominal wall To ax川ary lymph node from region above umbilicus To superficial inguinal lymph node from region below umbilicus To lumbar lymph node from post wall of abdomenLymphatic drainage of abdominal viscera Lumbar lymph nodes腰淋巴结 Lie on posterior abdominal wall,along the abdominal aorta and inferior vena cava Receive lymph from kidneys,suprarenal glands,testes,ovarirs,fundus of uterus,ovary,and common iliac nodes Right and left lumbar trunks formed by efferent vessel Paired visceradrain to the lumbar lymph nodes Celiac lymph nodes 腹腔淋巴结situated around the celiac trunk Superior mesenteric lymph node肠系膜上淋巴结 situated around superior mesenteric a.Inferior mesenteric lymph node肠系膜下淋巴结 situated around inferior mesenteric a.Intestinal trunk 腹腔干 formed by efferent vessel of celiac,superior and inferior lymph nodesThoracic duct 胸导管 Begins in front of L1 as a dilated sac,the cisterna chyli,which formed by joining of left and right lumbar trunks and intestinal trunk Enter 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 vein Travels upward,veering to the left at the level of T5 At the roof of the neck,it turns laterally and arches forwards and descends to enter the left venous angle Just before termination,it receives the left jugular,subclavian and bronchomediastinal trunks Drains lymph from lower limbs,pelvic cavity,abdominal cavity,left side of thorax,and left side of the head,neck and left upper limbSpleen 将Location:lies in the left hypochondriac region(between stomach and diaphragm)deep to the 9th to 11 th rib5 its long axis corresponds roughly to the 10th ribShapereddish in colourTwo surfaces Diaphragmatic:smooth,convex Visceral:concave,hilum of spleenTwo extremities Anteriorwider PosteriorrounderTwo border Superiorhas 2-3 splenic notch 脾切迹，which serve as a landmark on palpation when it is enlarge;normally it is not palpable InferiorrounderFunctions:the spleen is considered to be important in:Formation of lymphocytes and monocyte Phagocytosis of bacteria,inert particles and white blood cells and platelets Destroying effete or abnormal red blood cells Making antibodiesRalationships of spleen Diaphragmaticsurfacediaphragm Visceral surface Anteriorlyfundus of stomach Posteriorlyleft suprarenal gland and kidney Inferiorlytail of pancreas and left colic flexureNervers of abdomenLumbar plexus 腰丛 Formation:formed by anterior rami of L1-L3,a part of anterior rami of T12and L4 Position:lies within substance of psoas majorBranches Iliohypogastric n.骼腹下神经 Supplies lower part of anterior abdominal wall Ilioinguinal n.骼腹股沟神经 Passes through inguinal canal to supply skin of the groin and scrotum Lateral femoral cutaneous 股外侧皮神经 Femoral n.股神经 Obturator n.闭孔神经 Genitofemoral n.生殖股神经Lumbar sympathetic trunk 腰 衣感干 Made up of paired chains with four to five lumbar ganglia anterolateral to vertebral column Enters abdomen via the diaphragm and as a continuation of he thoracic part Passes inferiorly behind common iliac vessels and terminations by joining to form unpaired ganglion impar,anterior to sacrumAbdomen 3山东大学医学院解剖教研室 李振华Relationships of abdominal viscera First layerlive,gallbladder,stomach Second layerduodenum,pancreas,spleen Third layersuprarenal gland,kidney,ureter,inferior vena cava3 abdominal aorta,nerves and lymphaticsRelationships of the stomach Anterior: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 gland Left kidney Spleen Transverse colon and transvers mesoclonArteries 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 5 and anastomose end-to-end.Right and left 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 supply 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.Venous drainage Right and left gastric veins empty directly into hepatic portal vein.Left gastroepiploic and short gastric veins drain into hepatic portal vein via the splenic vein.Right gastroepiploic vein join either superior mesenteric vein.Lymphatics of stomach Right and left gastric In.lie along the same vessels and finally to the celiac In.Right and left gastroomental In.lie along the same vessels,the former drain into subpyloric In.,the latter drain into splinic In.Supra-and subpyloric In.receive lymphatics from pyloric part and finally to the celiac In.Splenic In.receive lymphatics from fundus and left third of stomach,and finally to the celiac In.Nerve supplyParasympathetic innervation by anterior(left)and posterior(right)vagal trunks The anterior trunk divides into anterior gastric and hepatic branches The posterior trunk divides into posterior gastric and celiac branches The anterior and posterior gastric branches descend 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 ganglia Affent and effent fibers derives from thoracic segments(T5 L1The duodenumRelationships of superior part Anteriorly Quadrate lobe of live Gallbladder