Anatomy 210 abdomen & pelvis for semester ii year 2012-2013

Abdomen & Pelvis

Mehrez M. JadaonFaculty of Allied Health Sciences

Kuwait University

Faculty of Allied Health SciencesCourse 210 anatomy

Semester II – 2012/2013

Objectives

- To define the abdomen and pelvis in the human body

- To describe the abdominal regions- To describe the different components of the

abdominopelvic cavity, including skin, fascia, muscles, peritoneum, bones, blood vessels, nerves and internal organs.

Abdomen-pelvis(Abdominopelvis)

en pelvis

Abdomen-pelvis

The abdomen (the belly): Space between thorax (chest) and pelvis. The diaphragm muscle forms the upper barrier.At the level of the pelvic bones, the abdomen ends and the pelvis begins.

The pelvis (the basin) is the area Below the abdomen (at the level of the pelvic bones) and ends at the area between the thighs.

• Superiorly extends to the 4th intercostals space (level of the male nipple)

• The upper part of the abdomen is protected by the bony thoracic cage (cartilage of ribs 7-10 & tips of ribs 11 & 12)

• The lower part of the abdomen is protected by the bony pelvis, and continues into pelvic cavity

• The posterior part of the abdomen is protected by the vertebral column (L1-L5)

• The anterior part and lateral part of the abdomen is protected by the muscular wall

- Xiphoid process X - Costal cartilages (ribs 7-10) - Tips of ribs 11 & 12 - Vertebrae L1-L5 - Iliac crests IC - Tubercle of the crest TC - Anterior superior iliac spine ASIS - Anterior inferior iliac spine AIIS - Inguinal ligament IL - Pubic tubercle PT - Pubic crest PC - Pubic symphysis PS - Pelvic brim PB

Abdomen

Abdominal regionsSurface anatomy

Trans-umbilical Plane(L3 & L4)

Median plane dividing body into 2 halves)

Right hypochondriac

Lefthypochondriac

Right Lumbar

LeftLumbar

Right Iliac

LeftIliac

Epigastric

Umbilical

Hypogastric

Abdomen structure

- Abdominal wall- Internal organs

Abdominal wall:- Anterior wall- Right and Left Lateral walls- Posterior wall

Anterolateral abdominal wall

Abdomen structure

Anterolateral abdominal wall From outside inwards:

- Skin- Superficial Fascia (fat) - 3 Muscles (with

deep fascia in between)

- Parietal peritoneum

Abdomen structure

SkinSuperficial Fascia 3 Muscles Parietal peritoneum

Abdomen structure

3 Flat anterolateral muscles(from outside inwards):

1- External Oblique2- Internal Oblique3- Transverse abdominal

Right & Left musclesConnected anteriorly byRectus sheath, with central Linea alba

Abdomen structure

Anterolateral abdominal wall4th anterolateral muscle:Rectus Abdominis muscle (within Rectus sheath), having Tendinous intersections

and Linea alba

Abdomen structure

Rectus Abdominis muscle (within Rectus sheath)

Abdomen structureAnterolateral abdominal wall muscles

Abdomen structureAnterolateral abdominal wall musclesOrigin, Insertion, Innervation, and action

Abdomen structurePosterior abdominal wall muscles

Abdomen systems and organs

Most of digestive organs and accessories

Kidneys and uretersSpleenAdrenal glands + Isles of

Langerhans

[Muscles, bones, nerves, blood vessels]

Digestive System:

EsophagusLower part penetrates the diaphragm through opening

[esophageal hiatus]

StomachCardia, Fundus, Body

& PylorusGreater and lesser

curvatures

Digestive System:

Small IntestinesDuodenum, Jejunum, Ileum

Large Intestines (colon)Cecum and AppendixAscending, Descending,

Transverse and sigmoid colonRectum and Anus

Digestive System:

Liver- Covered by peritoneum except bare area (posterior)

contacting the diaphragm.- Main two lobes (right and left) + Caudate and Quadrate

lobes- Infereior vena vaca forms a groove within the bare area- Falcifarm ligament, round ligament- Gallbladder

Digestive System:

Anterior view Posterior view

Bare areaGastric area

Duodenalarea

Pyloricarea

Digestive System:

Pancreas

Stomach

Pancreas

Small Intestines

LargeIntestines

Level of L2

Head adjacent to Stomach pylorusBody Tail is anterior to Left kidney and in position with splenic Hilum and left colic flexure

Digestive System:

Pancreas

Spleen

Spleen Surrounded by: Stomach from anteriorDiaphragm from posterior

Left (splenic) flexure of colon from inferiorLeft kidney from medial

Spleen Surrounded by: Stomach from anteriorDiaphragm from posterior

Left (splenic) flexure of colon from inferiorLeft kidney from medial

Spleen

Urinary system

KidneysLie deep to the 12th rib posteriorlyOpposite to T12-L3Right kidney is little lower because of liver

Posterior view

Urinary system

Ureters

From hilum of kidneys, going inferiorly towardsthe urinary bladder, anterior to the tipsof the transverse processes of thelumbar vertebrae

Urinary system

Adrenal glands (suprarenal)

Urinary system

Posterior view

PeritoneumEpithelia + connective tissue, folds, - binds organs to each other and to the abdominal

wall- contains blood and lymph vessels and nerves

(provide passage or routes).

1- Parietal peritoneumLines abdominal walls from inside

Peritoneal cavity (serous fluid)

2- Visceral peritoneum (=serosa layer)Surround organs from outside

Peritoneum

Extensions:- Greater omentum: Folded membrane hanging from stomach

(greater curvature) and proximal duodenum to cover the intestines, folding back to transverse colon.

- Lesser omentum: suspending stomach (lesser curvature) andproximal duodenum from liver

- Mesentry: attaching the small intestine to the posterior wall- Mesocolon: attaching the colon to the posterior wall- Mesoappendix: appendix to cecum and ileum- Ligaments: folds connecting organs together:

e.g. Falciform ligament: attaching the liver to the anterior wall and the diaphragm

e.g. Gastrosplenic ligamente.g. Gastrocolic ligamente.g. splenorenal ligament

Peritoneum

Abdomen systems and organsPeritoneum

Peritoneum

Female

Abdomen systems and organsPeritoneum

Mesocolon

Mesoappendix

Peritoneum

- Peritoneal organsDigestive organs that keep their mesentery

- Retroperitoneal organs Behind the peritoneume.g. kidneys, ureter, part of colon, rectum, reproductive organs

Peritoneum

- Peritoneal organs- Retroperitoneal organs

PelvisInferior and posterior to abdomen, separate it from

lower limbs

Margins: - Anterior: inferior anterolateral abdominal wall- Posterior: gluteal region of lower limbs- Inferior: Perineum (area between thighs containing

external sex organs and the anus)Lesser & Greater PelvesInside: Pelvic Cavity surrounded by bony Pelvic GirdlePelvic Girdle: Hip bones (Rt & Lt Ilium, Ischium & Pubis)

+ Sacrum (fused sacral bones S1-5)Pelvic cavity is separated from the perineum by pelvic diaphragm muscle

Pelvis

PelvisPelvic Girdle: Hip bones (Rt & Lt Ilium, Ischium & Pubis)

+ Sacrum (fused sacral bones S1-5)

Pelvic systems and organsUrinary System

UretersUrinary BladderUrethra

Pelvic systems and organsReproductive SystemMale

(Pelvic cavity and perineum)

Pelvic systems and organsReproductive SystemMale

Tunica albuginea:

white connective tissuecovering testis and extend internally

Pelvic systems and organsReproductive SystemFemale

2 ovaries, almond shape & sizeFixed by ligaments: Mesovarium: double layer of peritonium surrounds ovaries Ovarian ligament: attach to uterus Suspensory ligament:

attach to pelvic wall

Pelvic systems and organsReproductive SystemFemale

UterusBroad ligament

Blood Vessels & Nerves

Blood VesselsDiaphragm openings:

Inferior

Blood Vessels

ArteriesAorta Many branchesIn abdomen: Abdominal Aorta:

- passes through the diaphragm at the level of T12 vertebra.(through aortic hiatus)

- passes inferiorly on the bodies of the lumbar vertebrae.

- divides into the common iliac arteries at the level of L4.

Blood Vessels

ArteriesAorta Many branchesIn abdomen: Abdominal Aorta: Branches:

1) Parietal branches (to body wall structures)2) Visceral branches (to the visceral organs)

Blood Vessels

ArteriesAbdominal Aorta 1) Parietal branches 3 branches: first two are paired and the third is unpaired:1- Inferior phrenic arteries: First paired branches of the abdominal aorta. supply the inferior surface of the diaphragm and adrenal gland2- Lumbar arteries: Four pairs arise from the posterior-lateral surface of

the abdominal aorta. Supply the lumbar vertebrae, spinal cord and its menenges and the muscles and skin of the lumbar region at the back

3- Median sacral: Supplies the sacrum and coccyx

Blood Vessels

ArteriesAbdominal Aorta 1) Parietal branches

Blood VesselsArteriesAbdominal Aorta 1) Parietal branches

Left lumbers

Median sacral

Blood Vessels

ArteriesAbdominal Aorta 2) Visceral branches

6 branches:

- 3 paired visceral branches arise from the lateral surface of the abdominal aorta.

- 3 unpaired visceral branches arise from the anterior surface of the abdominal aorta.

Blood Vessels

ArteriesAbdominal Aorta 2) Visceral branches [from up downwards]:

3 Paired visceral branches:

1- Suprarenal arteries- Supplies the adrenal gland 2- Renal arteries- Supplies kidneys, adrenal gland and ureter 3- Gonadal:

Testicular in males- Supply testes, epididymis and uretersOvarian in females- Supply ovaries, uterine tube

and ureters

Blood Vessels

ArteriesAbdominal Aorta 2) Visceral branches [from up downwards]:

3 Unpaired visceral branches:

1- Celiac trunk (unpaired branches) 2- Superior mesenteric artery (unpaired branches) 3- Inferior mesenteric artery (unpaired branches)

Blood Vessels

ArteriesAbdominal Aorta 2) Visceral branches [from up downwards]:All

1- Celiac trunk (unpaired branches) 2- Superior mesenteric artery (unpaired branches)3- Suprarenal (adrenal) middle arteries

(paired: left & right)4- Renal arteries (paired: left & right)5- Gonadal (testicular or ovarian) arteries

(paired: left & right)6- Inferior mesenteric artery (unpaired branches)

Blood Vessels

ArteriesAbdominal Aorta 2) Visceral branches

Blood VesselsArteriesAbdominal Aorta 2) Visceral branches

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

Arteries 2

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

Arteries

Blood Vessels

VeinsInferior vena cava

Blood Vessels

VeinsInferior vena cava

Blood Vessels

VeinsUnlike arteries, veins from small and large intestines, spleen and pancreas go first to the liver before going to inferior vena cava through hepatic veins (hepatic portal circulation)

Blood Vessels

Inferior mesenteric vein

Splenic

Superiormesenteric vein

Blood Vessels

Nerves

Anterior rami (branches) of the lower six thoracic (T7-12) and first lumbar nerves (L1):

- T7-T11: Thoracoabdominal- Anterior ramus of T12:

Subcostal- First lumbar nerve L1: Iliohypogastric and ilioinguinal nerves.

Nerves

NervesSympathetic and parasympathetic (autonomic) nerves Internal organs (viscera)

The Vagus nerves (CN X, right and left) penetrating diaphragm at esophageal hiatus anterior and posterior vagal trunks

The abdominopelvic splanchnic nerves:1. Lower thoracic:

- Greater splanchnic (T5-T9 or T10)- Lesser splanchnic (T10-T11)- Least splanchnic (T12)

2. Lumbar splanchnic (L1-L3)Pelvic splanchnic (S2-S4)

Plexuses & ganglia organs

Nerves

NervesSympathetic and parasympathetic (autonomic) nerves Internal organs (viscera)

The Vagus nerves (CN X, right and left) penetrating diaphragm at esophageal hiatus anterior and posterior vagal trunks

The abdominopelvic splanchnic nerves:1. Lower thoracic:

- Greater splanchnic (T5-T9 or T10)- Lesser splanchnic (T10-T11)- Least splanchnic (T12)

2. Lumbar splanchnic (L1-L3)Pelvic splanchnic (S2-S4)

Plexuses & ganglia organs

Nerves

Plexuses: Nerve networks surrounding blood vessels or organse.g. Abdominal (para-aortic) autonomic plexuses surrounding

abdominal aorta and its branches: celiac, superior mesenteric and inferior mesenteric plexuses

Ganglia: Mass of nerve cells or fibers. They interact and form plexuses.e.g. celiac ganglion, superior and inferior mesenteric ganglia

NervesPlexuses & Ganglia:

Anatomy 210 abdomen & pelvis for semester ii year 2012-2013

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