腹部解剖圖譜PPT課件

1、Anterior wall Layers ( from superficial to deep)Skin Superficial fasciaAnterolateral musclesTransversalis fascia 腹橫筋膜Extraperitoneal fascia 腹膜下筋膜Parietal peritoneum 壁腹膜 第1頁/共83頁Superficial fasciadivisions below umbilicusSuperficial fatty layer (Campers)Membranous layer (Scarpas)第2頁/共83頁 Muscles of a

2、bdomenAnterolateral groupObliquus externus absominis 腹外斜肌Oblequus enternus abdominis腹內(nèi)斜肌Transversus abdominis腹橫肌Rectus abdominis 腹直肌第3頁/共83頁Posterior group Quadiatus lumborum 腰方肌Psoas major 腰大肌第4頁/共83頁Obliquus externus absominis 腹外斜肌腹外斜肌General direction of fibers: downward, forward and medially (ru

3、n down and inward)StructuresInguinal ligament 腹股溝韌帶Lacunar ligament 腔隙韌帶Superficial inguinal ring 腹股溝淺環(huán) triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle第5頁/共83頁第6頁/共83頁Obliquus internus abdominis 腹內(nèi)斜肌腹內(nèi)斜肌Deep to obliquus externus abdominisGeneral direction

4、of fibres: upwards, forwards and medially第7頁/共83頁Transversels abdominis 腹橫肌腹橫肌Deep to obliquus internus 第8頁/共83頁Inguinal falx 腹股溝鐮: arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睪肌: around the spermatic cord and testis第9頁/共83頁Rectu

5、s abdominis 腹直肌腹直肌Position: lie on to either of midlineOrigin: pubic crest and symphysisInsertion: xiphoid and 5th-7th costal cartilagesHas 3-4 tendinous intersections 腱劃linea semiluaris 半月線 第10頁/共83頁Similar functions for above four pairs of muscles Support and compress the abdominal viscera Increas

6、e 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 column第11頁/共83頁Sheath of rectus abdominis 腹直肌鞘腹直肌鞘Ant layerformed by fusion of apo

7、neurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominisPost layerFormed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominisAbsent in about 4-5cm below the umbilicus, where aponeuroses of al

8、l three muscles form anterior layer the lower free border named arcuate lineBelow this line rectus abdominis in contact with transverse fascia第12頁/共83頁Linea alba 白線tendinous raphe between right and left recti from xiphoid to pubic symphysis.第13頁/共83頁Inguinal region 腹股溝區(qū)腹股溝區(qū)Boundaries Inguinal ligame

9、nt Lateral margin of rectus abdominisA horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominis第14頁/共83頁Descent of testesSeven-week embryo showing the testis before its descent from the dorsal abdominal wall第15頁/共83頁Fetus at 28 week the testis passing through the ing

10、uinal canal第16頁/共83頁Newborn 第17頁/共83頁Inguinal canal 腹股溝管腹股溝管Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal lig.第18頁/共83頁BoundariesAnt wallAponeurosis of obliquus externus abdominisObliquus internus abdominis (lateral third of wall)第19頁/共83頁Post wallTransverse fascia

11、 Inguinal flax mediallyRoofarched lower fibers of obliquus internus and transversua abdominisFlooringuinal lig第20頁/共83頁Two openingsSuperficial inguinal ring 腹股溝淺環(huán)Deep inguinal ring 腹股溝深環(huán) defect in transverse fascia 1.5cm above midpoint of inguinal ligament第21頁/共83頁Structures passing through the ingu

12、inal canal Spermatic cord 精索 and ilioinguinal nerve髂腹股溝神經(jīng) in males Round ligament of uterus 子宮圓韌帶and ilioinguinal nerve髂腹股溝神經(jīng) in females 第22頁/共83頁Inguinal Triangle (of Hesselbach) 腹股溝腹股溝三角三角 Boundaries Inguinal ligament inferiorlyLateral border of rectus abdominis medially Inferior epigastric artery

13、 laterally第23頁/共83頁Indirect inguinal heinia and direcet inguinal heinia 第24頁/共83頁Superficial vessels and cutaneous nerves Arteries Superficial epigastric a.Superficial iliac circumflex a.Veins Thoracoepigastric v.Superficial epigastric v.Cutaneous nervesAnterior and lateral cutaneous n. of lower six

14、 thoracic Iliohypogastric n. (first lumb nerves)第25頁/共83頁Deep vessels and nervesArteres Superior and inferior epigastric arterisLower posterior intercostal a.Subcostal a.Four lumbar a. 第26頁/共83頁Nerves Iliohypogastric n. 髂腹下神經(jīng)Arises from lubar plexusPasses forward in the interval between obliquus int

15、ernus and tranversus abdominisPieces obliquus internus abdominis 2.5 cm medial to anterior superior iliac spinePieces aponeurosis of obliquus externus abdominisabout 2.5 cm above superficial inguinal ringIlioinguinal n. 髂腹股溝神經(jīng)Runs parallel with iliohypogastric n. at a lower levelEnters inguinal cana

16、l and emerges through superficial inguinal ringGenitofemoral n. 生殖股神經(jīng)第27頁/共83頁Subcostal incision Muscle-splitting incisionTransverse incision Median or midline incisionLeft paramedian incisionSuprapubic incision第28頁/共83頁Abdomen 2山 東 大 學(xué) 醫(yī) 學(xué) 院山 東 大 學(xué) 醫(yī) 學(xué) 院 解 剖 教 研 室解 剖 教 研 室李 振 華李 振 華第29頁/共83頁Abdomin

17、al aorta 腹主動脈腹主動脈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 arteries 第30頁/共83頁Parietal branchesInferior phrenic a. 膈下動脈(one pair)Lumbar a. 腰動脈(four pairs of arteries that supply t

18、he posterior abdominal wall)Median sacral a. 骶正中動脈第31頁/共83頁Visceral branches Paired branches Middle suprarenal artery 腎上腺中動脈Renal artery 腎動脈Testicular (ovarian) artery 睪丸（卵巢）動脈第32頁/共83頁Unpaired branches Celiac trunk 腹腔干 a short thick vessel that arises from the front of aorta, at the level of T12Sup

19、erior mesenteric a. 腸系膜上動脈arises from the front of aorta, at the level of L2Inferior mesenteric a. 腸系膜下動脈 arises from the front of aorta, at level of L3第33頁/共83頁Left gastric a.Common hepatic a.Splenic a.Gastroduodenal a.Proper hepatic a.Right gastric a.Left branchRight branchCystic a. Short gastric

20、a. Left gastrioeploic a.Right gastroepiploic a.Superior pancreaticoduodenal a.Splemic branches Celiac trunk 第34頁/共83頁Celiac trunk 第35頁/共83頁Superior mesenteric a. Inf. pancresticodudenal a.Jejunal and ileal a.Ileocolic a.Appendicular a.Right colic a.Middle colic a. Superior Mesenteric v.第36頁/共83頁Infe

21、rior mesenteric a.Left colic a.Sigmoid a.Superior rectal a. Inferior mesenteric v.第37頁/共83頁Colic marginal artery第38頁/共83頁Relations of abdominal aortaAnteriorly (from above downward) Pancreas Ascending part of duodenum Radix of mesenteryPosteriorly Upper four lumber vertebrae On its right Inferior ve

22、na cavaOn its left Left sympathetic trunk第39頁/共83頁Veins of abdomen and pelvisInternal iliac vein 髂內(nèi)靜脈 Parietal tributaries: accompany with arteries Visceral tributaries superior rectal veininferior mesenteric v.Rectal venous plexus inferior rectal veininternal iliac v.直腸靜脈叢 anal veininternal pudenda

23、l v. Vesical venous plexus 膀胱靜脈叢vesical v.Uterine venous plexus 子宮靜脈叢uterine v. 第40頁/共83頁 External iliac vein 髂外靜脈 accompany the arteryCommon iliac vein 髂總靜脈 formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4L5 by uniting each other to form inferior vena c

24、ava第41頁/共83頁Inferior vena cava 下腔靜脈下腔靜脈Formed by union of two common iliac veins anterior to and just to the right of L4L5Ascends on the right side of aorta, pierces vena cava foramen of diaphragm opposite the T8 and drains into the right atriumConveys blood from the whole body below the diaphragm t

25、o the right atrium 第42頁/共83頁Chief tributariesParietalPaired inferior phrenic v. 膈下靜脈paired lumbar v. 腰靜脈 (four)VisceralRight and left renal veins 左、右腎靜脈Right suprarenal vein 右腎上腺靜脈 (left drain into left renal vein) Right testicular or ovarian v右睪丸（卵巢）靜脈. (left drain into left renal vein)Hepatic vein

26、s 肝靜脈: right, left and intermediate第43頁/共83頁Relations of inferior vena cavaAnteriorly (cranially to caudally)LiverHead of pancreasHorizontal part of duodenumRight testicular (or ovarian) a.Radix of mesenteryPosteriorly Right crus of diaphragmUpper four lumber vertebraeLeft sympathetic trunkParietal

27、branches of abdominal aorta On its right Psoas majorRight kidneyRight suprarenal glandOn its left Abdominal aorta第44頁/共83頁Hepatic portal vein 肝門靜脈肝門靜脈General featuresFormed behind the neck of pancreas by the union of superior mesenteric vein and splenic vein Ascends upwards and to the right, posteri

28、or 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, p

29、ancreas, gall bladder, bile ducts and spleen第45頁/共83頁Variation and anomalies of hepatic portal vein第46頁/共83頁Tributaries of hepatic portal vein 1. Superior mesenteric v. 腸系膜上靜脈2. Inferior mesenteric v. 腸系膜下靜脈3. Splenic v. 脾靜脈4. Left gastric v. 胃左靜脈5. Right gastric v.胃右靜脈6. Cystic v. 膽囊靜脈7. Paraumbili

30、cal v. 附臍靜脈第47頁/共83頁Portal-systemic anastomoses1. At the lower end of the oesophagus Hepatic portal vein left gastric vein esophageal venous plexus esophageal vein azygos vein superiorvena cava2. At rectal venous plexus Hepatic portal vein splenic vein inferior mesenteric vein superior rectal vein r

31、ectal venous plexus inferior rectal and anal veins internal iliac vein inferior vena cava3. At periumbilical venous plexus Hepatic portal veinparaumbilical veinperiumbilical venous plexusthoracoepigastric and superior epigastric vein superiorvena cavasuperficial epigastric and inferior epigastric ve

32、ins inferior vena cava第48頁/共83頁4. Portal-retroperitoneal anastomosis Between 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 w

33、ith systemic retroperitoneal veins 第49頁/共83頁The lymphatic drainage of abdomenLymphatic drainage of abdominal wallTo axillary lymph node from region above umbilicusTo superficial inguinal lymph node from region below umbilicusTo lumbar lymph node from post wall of abdomen第50頁/共83頁Lymphatic drainage o

34、f abdominal visceraLumbar lymph nodes 腰淋巴結(jié)Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cavaReceive lymph from kidneys, suprarenal glands, testes, ovarirs, fundus of uterus, ovary, and common iliac nodesRight and left lumbar trunks formed by efferent vesselPaired visce

35、radrain to the lumbar lymph nodes第51頁/共83頁Celiac lymph nodes 腹腔淋巴結(jié) situated around the celiac trunk Superior mesenteric lymph node 腸系膜上淋巴結(jié) situated around superior mesenteric a. Inferior mesenteric lymph node 腸系膜下淋巴結(jié) situated around inferior mesenteric a. Intestinal trunk 腹腔干 formed by efferent vess

36、el of celiac, superior and inferior lymph nodes第52頁/共83頁Thoracic duct 胸導(dǎo)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 trunkEnter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends alo

37、ng on the front of the vertebral column, between thoracic aorta and azygos veinTravels upward, veering to the left at the level of T5At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angleJust before termination, it receives the left jugular, subcl

38、avian and bronchomediastinal trunksDrains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb第53頁/共83頁Spleen 脾脾Location: lies in the left hypochondriac region (between stomach and diaphragm) deep to the 9th to 11th rib, it

39、s long axis corresponds roughly to the 10th ribShapereddish in colour第54頁/共83頁Two surfaces Diaphragmatic: smooth, convexVisceral: concave, hilum of spleenTwo extremities AnteriorwiderPosteriorrounderTwo border Superiorhas 2-3 splenic notch 脾切跡, which serve as a landmark on palpation when it is enlar

40、ge; normally it is not palpableInferiorrounderFunctions: the spleen is considered to be important in:Formation of lymphocytes and monocytePhagocytosis of bacteria, inert particles and white blood cells and plateletsDestroying effete or abnormal red blood cellsMaking antibodies第55頁/共83頁Ralationships

41、of spleenDiaphragmatic surfacediaphragmVisceral surfaceAnteriorlyfundus of stomachPosteriorlyleft suprarenal gland and kidneyInferiorlytail of pancreas and left colic flexure 第56頁/共83頁Nervers of abdomen Lumbar plexus 腰叢Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4

42、Position: lies within substance of psoas major第57頁/共83頁Branches Iliohypogastric n. 髂腹下神經(jīng)Supplies lower part of anterior abdominal wallIlioinguinal n. 髂腹股溝神經(jīng)Passes through inguinal canal to supply skin of the groin and scrotum Lateral femoral cutaneous 股外側(cè)皮神經(jīng)Femoral n. 股神經(jīng)Obturator n. 閉孔神經(jīng)Genitofemor

43、al n. 生殖股神經(jīng)第58頁/共83頁Lumbar sympathetic trunk 腰交感干腰交感干Made up of paired chains with four to five lumbar ganglia anterolateral to vertebral columnEnters abdomen via the diaphragm and as a continuation of he thoracic partPasses inferiorly behind common iliac vessels and terminations by joining to form

44、unpaired ganglion impar, anterior to sacrum第59頁/共83頁Abdomen 3山 東 大 學(xué) 醫(yī) 學(xué) 院山 東 大 學(xué) 醫(yī) 學(xué) 院 解 剖 教 研 室解 剖 教 研 室李 振 華李 振 華第60頁/共83頁Relationships of abdominal viscera First layerlive, gallbladder, stomach Second layerduodenum, pancreas, spleen Third layersuprarenal gland, kidney, ureter, inferior vena cava

45、, abdominal aorta, nerves and lymphatics第61頁/共83頁 Relationships of the stomachAnterior: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 glandLeft kidneySpl

46、een Transverse colon and transvers mesoclon第62頁/共83頁Arteries 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 , and anastomose end-to-end.第63頁/共83頁Right and left gastroepiploic art

47、eries 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 o

48、f stomach. Posterior gastric artery (72%) arise from the splenic artery, course through the gastrophrenic ligament and supply the posterior wall of fundus of stomach.第64頁/共83頁Venous drainageRight and left gastric veins empty directly into hepatic portal vein.Left gastroepiploic and short gastric vei

49、ns drain into hepatic portal vein via the splenic vein.Right gastroepiploic vein join either superior mesenteric vein.第65頁/共83頁Lymphatics of stomach Right and left gastric ln. lie along the same vessels and finally to the celiac ln.Right and left gastroomental ln. lie along the same vessels, the for

50、mer drain into subpyloric ln., the latter drain into splinic ln.Supra- and subpyloric ln. receive lymphatics from pyloric part and finally to the celiac ln.Splenic ln. receive lymphatics from fundus and left third of stomach, and finally to the celiac ln. 第66頁/共83頁Nerve supplyParasympathetic innerva

51、tion by anterior (left) and posterior (right) vagal trunksThe anterior trunk divides into anterior gastric and hepatic branchesThe posterior trunk divides into posterior gastric and celiac branchesThe anterior and posterior gastric branches descend on the anterior and posterior surfaces of the stoma

52、ch 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 gangliaAffent and effent fibers derives from thoracic segments

53、 (T5 L1第67頁/共83頁The duodenumRelationships of superior part AnteriorlyQuadrate lobe of liveGallbladderPosteriorlyCommom bile duct Gastroduodenal a.Hepatic portal v.Inferior vena cavaSuperioely Omental foramenInferiorly Head of pancreas 第68頁/共83頁Relationships of descending partAnteriorlyLive Transvers

54、e colon and mesocolonLoops of small intestine Posteriorly Right renal hilum and ureterRight renal vesselsMediallyHead of pancreasCommon bile duct and pancreatic ductLaterally Right colic flexure第69頁/共83頁Relationships of horizontal partSuperiorlyHead of pancreasInferiorly Loops of small intestine Ant

55、eriorlyRadix of mesenterySuperior mesenteric a. and v. PosteriorlyRight ureterInferior vena cavaAbdominal aorta 第70頁/共83頁Relationships of ascending partRight Head of pancreas and abdominal aortaLeft Left kidney and ureter第71頁/共83頁Relationships of liverDiaphragmatic surfaceseparated by diaphragm from

56、 the following Right costodiaphramatic recess and lungCardiac baseVisceral surfaceLeft lobe is related to the stomach and abdominal part of esophagus Right lobe is related to the right colic flexure anteroly, gallbladder and superior duodenal flexure medially, right kidney, superarenal gland posteriorly第72頁/共83頁Blood supply Arteries Superior pancreaticoduodenal a.Inferior pancreaticoduodenal a.Veinsfollow arteries, draining directly into superior mesenteric and hepatic portal veins 第73頁/共83頁Divisions and relations of common bile ductSupraduodenal segment Descends alon