The document discusses the anatomy and clinical applications of the gastrointestinal tract and its related structures. It describes the layers of the abdominal wall and muscles. It details the anatomy of the esophagus, stomach, small intestine, large intestine, rectum, anal canal and related structures like the liver. It discusses the blood supply, innervation and clinical conditions like hernias, ulcers and cancers that can affect these structures.
The document discusses the anatomy and clinical applications of the gastrointestinal tract and its related structures. It describes the layers of the abdominal wall and muscles. It details the anatomy of the esophagus, stomach, small intestine, large intestine, rectum, anal canal and related structures like the liver. It discusses the blood supply, innervation and clinical conditions like hernias, ulcers and cancers that can affect these structures.
The document discusses the anatomy and clinical applications of the gastrointestinal tract and its related structures. It describes the layers of the abdominal wall and muscles. It details the anatomy of the esophagus, stomach, small intestine, large intestine, rectum, anal canal and related structures like the liver. It discusses the blood supply, innervation and clinical conditions like hernias, ulcers and cancers that can affect these structures.
The document discusses the anatomy and clinical applications of the gastrointestinal tract and its related structures. It describes the layers of the abdominal wall and muscles. It details the anatomy of the esophagus, stomach, small intestine, large intestine, rectum, anal canal and related structures like the liver. It discusses the blood supply, innervation and clinical conditions like hernias, ulcers and cancers that can affect these structures.
Dr. A Ibrahim Surface Landmarks & Abdominal Planes • Surface landmarks • Superior border • Xiphoid process • Costal cartilages of the 7th – 10th ribs • Middle: Umbilicus is at the midline between the L3 and L4 • Inferior border • Inguinal ligament: • Created by the inferior border of the external oblique muscle & aponeurosis • Puic crest and pubic symphysis Layers of the abdomen Skin Camper fascia Superficial fascial Scarpa fascia External oblique
Lateral wall Internal oblique
Transversus Muscles abdominis
Rectus abdominis Transaverlis fascia Anterior wall Pyramidalis Extraperitoneal fat
Peritoneum Lateral abdominal (flat) muscles Anterior abdominal (vertical) muscles Rectus Sheath Vasculature of Anterior Abdominal wall Innervation • The skin, abdominal muscles, and peritoneum • are innervated by: • Thoracoabdominal nerves (T7–T11) that run within the internal oblique and transversus abdominis muscle layers • Subcostal nerve (T12) • Iliohypogastric nerve (L1) • Ilioinguinal nerve • (L1) • Sensory • distribution: • Series of transverse dermatomal • bands from T7 to L1 • Skin • around the umbilicus is innervated by T10. In the clinic • Inguinal hernia • Caput medusae • A sign of portal hypertension that manifest by the appearance of dilated superficial epigastric veins radiating from the umbilicus. • Cullen’s sign • Hemorrhagic discoloration and edema around the umbilicus. In the clinic: Abdominal incisions and their indication Inguinal canal Inguinal • Borders (4 walls: Anterior, canal: posterior, roof & floor • At the level of deep ring borders & • At the middle
contents • At the level of superficial ring • Contents? • Biological male • Biological female Epidemiology In the clinic: Inguinal hernia Risk factors Hesselbach’s triangle? • Congenital Etiology • Acquired
• Medical history • Palpation Diagnosis • Imaging • Ultrasound, CT scans & MRI
• Surgical hernia repair
• Surgical techniques Management • Reinforcing the posterior wall of the inguinal canal with synthetic mesh • Reduction in the diameters of the inguinal rings The peritoneum: Structure • Parietal peritoneum • Lines the internal surface of abdominopelvic wall • Derived from somatic mesoderm • Receives the same somatic nerve supply as the region of the abdominal wall that it lines; pain from parietal peritoneum is well localized. • Sensitive to pressure, pain, laceration and temperature • Visceral peritoneum • Invaginates to cover most of the abdominal visceral. • Derived from splanchnic mesoderm • It has the same autonomic nerve supply as the viscera. Therefore, pain from visceral peritoneum is poorly localized. Only sensitive to stretch and chemical irritation. • NOTE: pain from visceral peritoneum is referred to areas of skin (dermatomes) which are supplied by the same sensory ganglia and spinal cord segments as the nerve fibres innervating the viscera. The peritoneum: Intraperitoneal and retroperitoneal
• Intraperitoneal organs (associated with
visceral peritoneum) • Stomach, liver and spleen • Retroperitoneal organs (associated with parietal peritoneum) • Primary & secondary • Retroperitoneal mnemonic: • SAD PUCKER The peritoneum: Peritoneal reflections
• Mesentery • Small intestine = mesentery • Transverse colon – transverse mesocolon • Sigmoid colon = sigmoid mesocolon • Appendix = mesoappendix • Omentum • Greater omentum (‘abdominal policeman’) • Lesser omentum • Hepatogastric ligament • Hepatoduodinal ligament In the clinic: Referred pain The peritoneal (Abdominal) Cavity • The peritoneal cavity is a potential space between the parietal and viscera peritoneum. • Subdivisions • Greater sac • Supracolic compartment • Infracolic compartment • Lesser sac (omental bursa) • The omental bursa is connected with the greater sac through an opening in the omental bursa – the epiploic foramen (of Winslow). Epiploic Foramen (of Winslow) Structure of the peritoneal cavity in the pelvis In the clinic: • Sampling of peritoneal fluid • Culdocentesis • Paracentesis • Disorders of the Peritoneal Cavity • Ascites • Peritonitis Gastrointestinal Tract Oesophagus • Function • Structure • Sphincters • Vasculature • Arteries • Veins (systemic & portal) • Nerves The Stomach • Functions • Anatomical relations • Sphincters • Arteries : left & right gastric, left & epiploic and short gastric Stomach: • Veins: follow the arteries • Nerve: Vascular supply • Parasympathetic (from from posterior trunk of vagus nerve (stimulatory)). • Sympathetic: splanchnic nerve (inhibit digestive activity) In the clinic • Acute gastritis • Gastric ulcer • Gastric cancer • Pyloric stenosis • Gastro-Oesophageal Reflux disease (GORD) • Symptoms – dysphagia, dyspepsia & unpleasant sour taste • Causes • Dysfunction of the lower oesophageal sphincter • Delayed gastric emptying • Hiatal hernia • Sliding hiatus hernia • Rolling hiatus hernia In the clinic: Hiatal hernia • A = normal • B = pre-stage • C = sliding hiatal hernia • D = rolling hiatal hernia • Duodenum (25cm) • D1 - Superior (at spinal level L1)
Small intestine: • Proximal to the major duodenal papilla – gastroduodenal artery
(from hepatic artery from the coeliac trunk
Vasculature • Distal to the major duodenal papilla – inferior pancreaticoduodenal artery (from superior mesenteric artery) • Duodenum & jejunum – Superior mesenteric artery. Large Intestine: cecum, appendix, colon (ascending, descending, sigmoid segment), rectum, and anal canal The Cecum
• 1st part of the large intestine
• Approximately 7.5–9 cm in length and breadth • Intestinal pouch between the terminal ileum (at the ileocecal junction) and the ascending colon • Located in the iliac fossa of the RLQ of the abdomen • Covered on all sides by peritoneum (= intraperitoneal), though has no mesentery (↓ mobility ) • Contains the opening into the appendix (appendiceal orifice) Appendix • Appendix: blind intestinal diverticulum off the cecum • Approximately 6–10 cm in length • Contains significant lymphoid tissue • Base arises from the posteromedial aspect of the cecum, inferior to the ileocecal junction. • Location of tail may be: • Retrocecal (65%) • Pelvic (30%) • Subcecal (2%) • Preileal (2%) • Postileal (1%)
Also: subileal at 3 o’clock, and paracecal at 10 o’clock
Colon: ascending, transverse, descending, sigmoid Colon: Unique gross features
Several anatomic features distinguish the large intestine from the small intestine and rectum, including: • Taenia coli: • 3 discrete bands of longitudinal muscle in the colonic wall (rather than a continuous longitudinal layer in the muscularis as seen in the small intestine): • Omental taenia: attaches to the greater omentum • Mesocolic taenia: attaches to the transverse mesocolon (which anchors the transverse colon to the posterior abdominal wall) • Free taenia coli: not attached to other structures • Contract to form the haustra • Haustra: • Sacculations in the colon created by contraction of the longitudinal taenia coli • Internally, these sacculations are separated by semilunar folds (protrusions of mucosa into the lumen) • Omental appendices (also called epiploic appendages): small, fatty, omentum-like projections Colone: vasculature Marginal artery (Drummond)? cecum, appendix, colon In the clinic • Cecal volvulus • Appendicitis • Diverticulosis/diverticulitis • Ischemic colitis • Colon polyps • Colorectal cancer (CRC) • Malrotation of the gut • Large bowel obstruction • Irritable bowel syndrome (IBS) Rectum and Anal canal Anatomical Relations of the Rectum
Anatomical Relations of the Anal canal
Rectum and Anal canal: Neurovasculature In the clinic • Fecal incontinence • Urge incontinence • Passive incontinence • Hemorrhoids • Perianal and perirectal abcesses • Anal fistula • Anal fissures • Rectal prolapse • Colorectal cancer (CRC) Accessory organs of GIT: The Liver The liver: surfaces, lobes and impressions The liver: Segments (Couinaud classification system) The liver: Ligaments • Subphrenic spaces The liver: • Subhepatic space
Full Download B D Chaurasia s Human Anatomy Regional Applied Dissection Clinical Volume 2 Lower Limb Abdomen Pelvis 8th Edition 2019 Krishna Garg PDF DOCX
Full Download B D Chaurasia s Human Anatomy Regional Applied Dissection Clinical Volume 2 Lower Limb Abdomen Pelvis 8th Edition 2019 Krishna Garg PDF DOCX
