腹部解剖圖譜PPT

1、Abdominal wall,山東大學(xué)醫(yī)學(xué)院 解剖教研室 李振華,Anterior wall,Layers ( from superficial to deep) Skin Superficial fascia Anterolateral muscles Transversalis fascia 腹橫筋膜 Extraperitoneal fascia 腹膜下筋膜 Parietal peritoneum 壁腹膜,Superficial fasciadivisions below umbilicus Superficial fatty layer (Campers) Membranous laye

2、r (Scarpas),Muscles of abdomen,Anterolateral group Obliquus externus absominis 腹外斜肌 Oblequus enternus abdominis腹內(nèi)斜肌 Transversus abdominis腹橫肌 Rectus abdominis 腹直肌,Posterior group Quadiatus lumborum 腰方肌 Psoas major 腰大肌,Obliquus externus absominis 腹外斜肌,General direction of fibers: downward, forward and

3、 medially (run down and inward) Structures Inguinal 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,Obliquus internus abdominis 腹內(nèi)斜肌,Deep to obliquus externus abdominis General direction

4、of fibres: upwards, forwards and medially,Transversels abdominis 腹橫肌,Deep to obliquus internus,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,Rectus abdominis 腹直肌,Position

5、: lie on to either of midline Origin: pubic crest and symphysis Insertion: xiphoid and 5th-7th costal cartilages Has 3-4 tendinous intersections 腱劃 linea semiluaris 半月線,Similar functions for above four pairs of muscles,Support and compress the abdominal viscera Increase intra-abdominal pressure, aid

6、 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,Sheath of rectus abdominis 腹直肌鞘,Ant layerformed by fusion of aponeurosis of obliquus externus abdominis an

7、d anterior leaf of aponeurosis of obliquus internus abdominis Post layer Formed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominis Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the

8、 lower free border named arcuate line Below this line rectus abdominis in contact with transverse fascia,Linea alba 白線 tendinous raphe between right and left recti from xiphoid to pubic symphysis.,Inguinal region 腹股溝區(qū),Boundaries Inguinal ligament Lateral margin of rectus abdominis A horizontal line

9、stretching from anterior iliac spine to laeral margin of rectus abdominis,Descent of testes,Seven-week embryo showing the testis before its descent from the dorsal abdominal wall,Fetus at 28 week the testis passing through the inguinal canal,Newborn,Inguinal canal 腹股溝管,Position: oblique passage, 4cm

10、 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 Floorin

11、guinal lig,Two openings Superficial 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,Structures passing through the inguinal 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

12、nerve髂腹股溝神經(jīng) in females,Inguinal Triangle (of Hesselbach) 腹股溝三角,Boundaries Inguinal ligament inferiorly Lateral border of rectus abdominis medially Inferior epigastric artery laterally,Indirect inguinal heinia and direcet inguinal heinia,Superficial vessels and cutaneous nerves,Arteries Superficial e

13、pigastric 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 nerves,Arteres Superior and inferior epigastric arteris Lower posterior i

14、ntercostal a. Subcostal a. Four lumbar a.,Nerves Iliohypogastric n. 髂腹下神經(jīng) 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 extern

15、us abdominisabout 2.5 cm above superficial inguinal ring Ilioinguinal n. 髂腹股溝神經(jīng) Runs parallel with iliohypogastric n. at a lower level Enters inguinal canal and emerges through superficial inguinal ring Genitofemoral n. 生殖股神經(jīng),Layer ?,Abdomen 2,山東大學(xué)醫(yī)學(xué)院 解剖教研室 李振華,Abdominal aorta 腹主動(dòng)脈,Continuation of t

16、horacic 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,Parietal branches Inferior phrenic a. 膈下動(dòng)脈(one pair) Lumbar a. 腰動(dòng)脈(four pairs of arteries that supply the posterior abdominal wall) Median sacra

17、l a. 骶正中動(dòng)脈,Visceral branches Paired branches Middle suprarenal artery 腎上腺中動(dòng)脈 Renal artery 腎動(dòng)脈 Testicular (ovarian) artery 睪丸（卵巢）動(dòng)脈,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. 腸系膜上動(dòng)脈arises from the front of ao

18、rta, at the level of L2 Inferior mesenteric a. 腸系膜下動(dòng)脈 arises from the front of aorta, at level of L3,Celiac trunk,Celiac trunk,Colic marginal artery,Relations of abdominal aorta Anteriorly (from above downward) Pancreas Ascending part of duodenum Radix of mesentery Posteriorly Upper four lumber vert

19、ebrae On its right Inferior vena cava On its left Left sympathetic trunk,Veins of abdomen and pelvis,Internal 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

20、 anal veininternal pudendal v. Vesical venous plexus 膀胱靜脈叢vesical v. Uterine venous plexus 子宮靜脈叢uterine v.,External iliac vein 髂外靜脈 accompany the artery Common 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 fo

21、rm inferior vena cava,Inferior vena cava 下腔靜脈,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 di

22、aphragm to the right atrium,Chief tributaries Parietal Paired inferior phrenic v. 膈下靜脈 paired lumbar v. 腰靜脈 (four) Visceral Right 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) Hepat

23、ic veins 肝靜脈: right, left and intermediate,Relations 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

24、Parietal branches of abdominal aorta On its right Psoas major Right kidney Right suprarenal gland On its left Abdominal aorta,Hepatic portal vein 肝門靜脈,General features Formed behind the neck of pancreas by the union of superior mesenteric vein and splenic vein Ascends upwards and to the right, poste

25、rior 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,

26、 pancreas, gall bladder, bile ducts and spleen,Variation and anomalies of hepatic portal vein,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. Paraumbilical v. 附

27、臍靜脈,Portal-systemic anastomoses 1. At the lower end of the oesophagus Hepatic portal vein left gastric vein esophageal venous plexus esophageal vein azygos vein superiorvena cava 2. At rectal venous plexus Hepatic portal vein splenic vein inferior mesenteric vein superior rectal vein rectal venous p

28、lexus inferior rectal and anal veins internal iliac vein inferior vena cava 3. At periumbilical venous plexus Hepatic portal veinparaumbilical veinperiumbilical venous plexus thoracoepigastric and superior epigastric vein superiorvena cava superficial epigastric and inferior epigastric veins inferio

29、r vena cava,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 with systemic retrop

30、eritoneal veins,The lymphatic drainage of abdomen,Lymphatic drainage of abdominal wall To axillary lymph node from region above umbilicus To superficial inguinal lymph node from region below umbilicus To lumbar lymph node from post wall of abdomen,Lymphatic drainage of abdominal viscera Lumbar lymph

31、 nodes 腰淋巴結(jié) 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

32、 nodes,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 vessel of celiac, superior and inferior

33、 lymph nodes,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 trunk Enter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column,

34、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 Dr

35、ains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb,Spleen 脾,Location: lies in the left hypochondriac region (between stomach and diaphragm) deep to the 9th to 11th rib, its long axis corresponds roughly to the 10th r

36、ib Shapereddish in colour,Two surfaces Diaphragmatic: smooth, convex Visceral: concave, hilum of spleen Two extremities Anteriorwider Posteriorrounder Two border Superiorhas 2-3 splenic notch 脾切跡, which serve as a landmark on palpation when it is enlarge; normally it is not palpable Inferiorrounder

37、Functions: 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 antibodies,Ralationships of spleen Diaphragmatic surfacediaphragm Visceral

38、surface Anteriorlyfundus of stomach Posteriorlyleft suprarenal gland and kidney Inferiorlytail of pancreas and left colic flexure,Nervers of abdomen,Lumbar plexus 腰叢 Formation: formed by anterior rami of L1-L3, a part of anterior rami of T12and L4 Position: lies within substance of psoas major,Branc

39、hes Iliohypogastric n. 髂腹下神經(jīng)Supplies lower part of anterior abdominal wall Ilioinguinal 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) Genitofemoral n. 生殖股神經(jīng),Lumbar sympathetic trunk 腰交感干,Made up of pai

40、red 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 sacrum,Abdomen 3,山東大學(xué)醫(yī)學(xué)院 解剖教

41、研室 李振華,Relationships of abdominal viscera,First layerlive, gallbladder, stomach Second layerduodenum, pancreas, spleen Third layersuprarenal gland, kidney, ureter, inferior vena cava, abdominal aorta, nerves and lymphatics,Relationships of the stomach,Anterior: Live (right part) Diaphragm (left uppe

42、r 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 mesoclon,Arteries of stomach,Left and right gastric arteries arise from celiac trunk and

43、 proper hepatic artery, repectively. These two vessels run in lesser omentum along lesser curvature , 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

44、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 posteri

45、or 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 R

46、ight 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 former drain into subpyloric ln., the latter drain into splinic ln. Supra- and subpyloric ln. receive lymphatics from pyloric part and finally to the ce

47、liac ln. Splenic ln. receive lymphatics from fundus and left third of stomach, and finally to the celiac ln.,Nerve supply Parasympathetic innervation by anterior (left) and posterior (right) vagal trunks The anterior trunk divides into anterior gastric and hepatic branches The posterior trunk divide

48、s 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 ca

49、lled “crows foot” to supply the pyloric part Sympathetic innervation Mainly from celiac ganglia Affent and effent fibers derives from thoracic segments (T5 L1,The duodenum,Relationships of superior part Anteriorly Quadrate lobe of live Gallbladder Posteriorly Commom bile duct Gastroduodenal a. Hepat

50、ic portal v. Inferior vena cava Superioely Omental foramen Inferiorly Head of pancreas,Relationships of descending part Anteriorly Live Transverse colon and mesocolon Loops of small intestine Posteriorly Right renal hilum and ureter Right renal vessels Medially Head of pancreas Common bile duct and

51、pancreatic duct Laterally Right colic flexure,Relationships of horizontal part Superiorly Head of pancreas Inferiorly Loops of small intestine Anteriorly Radix of mesentery Superior mesenteric a. and v. Posteriorly Right ureter Inferior vena cava Abdominal aorta,Relationships of ascending part Right

52、 Head of pancreas and abdominal aorta Left Left kidney and ureter,Relationships of liver,Diaphragmatic surfaceseparated by diaphragm from the following Right costodiaphramatic recess and lung Cardiac base Visceral surface Left lobe is related to the stomach and abdominal part of esophagus Right lobe is related to the right col