AnterolateralAbdominalWall

LearningObjiective

1.Knowsurfacelandmarksandregionsoftheanteriorabdominalwall.

2.Masterthemuscularcomponentsoftheanteriorabdominalwall.

3.Masterthelayersofanteriorabdominalwall.

4.Mastertheformationandfeaturesofsheathofrectusabdominis.Knowthebloodsupplyandinnervationsoftheanteriorabdominalwall.

5.Mastertheposition,formationofinguinalcanal.Masterthestructurespassingthroughtheinguinalcanal.

6.Mastertheboundariesofinguinaltriangle.

7.Knowtheanatomyofinguinalhernias.

Keystone

1.Themuscularcomponentsoftheanteriorabdominalwall.

2.Theformationandfeaturesofsheathofrectusabdominis.

3.Theposition,formationofinguinalcanal.

4.Theboundariesofinguinaltriangle.

QuestionsRequiringShortAnswer

1.Brieflydescribethelayersofanterolateralwallofabdomen.

2.Describetheposition,compositionandcontentsoftheinguinalcanal.

3.Brieflydescribetheboundariesofinguinaltriangle.

4.Describetheboundariesofinguinaltriangle.

ReadingandComprehension

Section1IntroductionoftheAbdomen

Ⅰ.Boundaries

Ⅰ)Superiorly－xiphoidprocess,costalarch,12thand11thribs,vertebraT12

Ⅱ)Inferiorly－

Ⅱ.Landmarksandsurfaceanatomy

1.Pubicsymphysis

2.Pubictubercle

3.Iliaccrest

4.Anteriorsuperioriliacspine

5.Umbilicus:atthelevelofL3~L4

6.Lineasemilunaris

7.Transpyloricplane:passesthroughthetipsoftheninthcostalcartilagesonthetwosides.Itisabouthalfwaybetweenthejugularnotchandthepubicsymphysis,orabouthalfwaybetweenthexiphoidprocessandtheumbilicus.Itliesatthelevelofthefistlumbarvertebra.Thisplanepassesthroughthepylorusofthestomach,theduodinojejunaljunction,theneckofthepancreas,andthehilaofthekidneys.

Ⅲ.Theabdominalregions

Referencestoquadrantsandregionsareusedtodescribethelocationofanatomicstructureswithintheabdomen,aswallastodescribesymptomsandtheresultsofphysicalexaminationspertainingtothisareartery

Ⅰ)Nineregions:Theabdomenisdividedinto9regionsbythehorizontalsubcostalplane(passesthroughthelowestpointofcostalarch)andhorizontalintertubercularplane(throughthetubercleofiliaccrest),aswellasthetwoverticalmidinguinalplanes,into:

1.Leftandrighthypochondriacregion,epigastricregion

2.L.andR.lateralregionsofabdomen,umbilicalregion

3.L.andR.inguinalregion,pubicregion

Ⅱ)Fourquadrants

1.Formedbyimaginaryverticalandhorizontallinesthroughumbilicus

2.Designatedasleftandrightupperquadrants,leftandrightlowerquadrants

Section2AnterolateralAbdominalWall

Ⅰ.Layers(fromsuperficialtodeep)

Ⅰ)Skin

Ⅱ)Superficialfascia－divisionsbelowumbilicus

1.Fattylayer(Camper’sfascia)iscontinuouswiththesuperficialfasciaovertherestofthebody.

2.Membranouslayer(Scarpa’sfascia)passesovertheinguinalligamenttofusethedeepfasciaofthethigh(fascialata)approximatelyonefingerbreadthbelowtheinguinalligament.Inthemidline,itisnotattachedtothepubisbutinsteadfromatubularsheathforthepenis(clitoris).Intheperineum,itisattachesoneachsidetothemarginsofthepubicarchandisknowasColles’fascia.

Ⅲ)Anterolateralmuscles

Ⅳ)Transversefascia

Ⅴ)Extraperitonealfascia

Ⅵ)Parietalperitoneum

Ⅱ.Superficialvesselsandcutaneousnerves

Ⅰ)Arteries

1.Superficialepigastrica.

2.Superficialiliaccircumflexa.

Ⅱ)Veins

1.Thoracoepigastricv.

2.Superficialepigastricv.

Ⅲ)Cutaneousnerves

1.Anteriorandlateralcutaneousn.oflowersixthoracic

2.Iliohypogastricn.(firstlumbnerves)

Ⅳ)Lymphdrainge

1.SuperficiallymphvesselsabovetheleveloftheumbilicusgrainupwardintothepectoralLn.

2.ThevesselsbelowthisleveldraindownwardintothesuperficialinguinalLn.

Ⅲ.Musclesoftheanterolateralabdominalwall

Ⅰ)Obliquusexternusabdominis

1.Generaldirectionoffibers:downward,forwardandmedially(rundownandinward)

2.Structures

(1)Inguinalligament

(2)Lacunarligament

(3)Superficialinguinalring－triangular-shapeddefectinaponeurosisofobliquusexternusabdominisabovepubictubercle

Ⅱ)Obliquusinternusabdominis:

1.Deeptoobliquusexternusabdominis

2.Generaldirectionoffibres:upwards,forwardsandmedially

3.Hasalower,freeborderthatarchesoverspermaticcord

Ⅲ)Transversusabdominis:Deeptoobliquusinternus

1.Generaldirectionoffibers:runhorizontallyforward.

2.Structuresformedbyobliquusinternusabdominisandtransversusabdominis

(1)Inguinalfalx:thelowesttendinousfidersofobliquusinternusabdominisinsertedwithtransversusfiberintomedialpartofpectenofpubisandpubiccresttoforminguinalfalx.

(2)Cremaster:aroundthespermaticcordandtestiswhichderivedfromthelowerfibersoftheobliquusinternusabdominisandtransversusabdominis

Ⅳ)Rectusabdominis

1.Position:lieontoeitherofmidline

2.Origin:pubiccrestandsymphysis

3.Insertion:xiphoidand5th-7thcostalcartilages

4.Tendinousintersections3-4

5.Lineasemiluaris

Ⅴ)Similarfunctionsforabovefourpairsofmuscles

1.Supportandcompresstheabdominalviscera

2.Increaseintra-abdominalpressure,aidinexpulsiveefforts-vomiting,coughing,sneezing,defecation,urinationandchildbirth.

3.Depressribs,assistin(theactofforce(4)expiration.

4.Flex,lateralflex,androtatevertebralcolumn

Ⅵ)Sheathofrectusabdominis

1.Anteriorlayer－formedbyfusionofaponeurosisofobliquusexternusabdominis

anteriorleafofaponeurosisofobliquusinternusabdominis

2.Posteriorlayer－formedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisaponeurosisoftransversusabdominis;Absentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuateline.Belowthislinerectusabdominisincontactwithtransversefascia

Ⅶ)Lineaalba－tendinousraphebetweenrightandleftrectifromxiphoidtopubicsymphysis.

Ⅵ.Deepvesselsandnervesofabdomen

Ⅰ)Arteries

1.Superiorandinferiorepigastricarteris

2.Lowerposteriorintercostalaa.

3.Subcostala.

4.Deepiliaccircumflexa.

5.Fourlumbara.

Ⅱ)Deepnervesofabdomen

1.lowerfiveintercostalsnervesandsubcostalnerveleavetheanteriorendsoftheirintercostalsspacesbypassingdeeptothecostalcartilagestoenterabdominalwallandrunbetweenobliquusinternusandtranversusabdominis.

2.Iliohypogastricn.:

(1)risesfromlumbarplexus

(2)Passesforwardintheintervalbetweenobliquusinternusandtranversusabdominis

(3)Piecesobliquusinternusabdominis2.5cmmedialtoanteriorsuperioriliacspine

(4)Piecesaponeurosisofobliquusexternusabdominisabout2.5cmabovesuperficialinguinalring

3.Ilioinguinaln.

(1)Arisesfromlumbarplexus

(2)Runsparallelwithiliohypogastricn.atalowerlevel

(3)Entersinguinalcanalandexitsthroughsuperficialinguinalring

(4)Suppliesthetransversusabdominis,obliquusinternus,andobliquuseexternusabdiminis.Italsosuppliestheskinjustabovethesymphysispubisandthescrotumorgreaterlipofpudendum.

4.Genitofemoraln.

(1)Arisesfromlumbarplexus

(2)Emergesthroughsuperficialinguinalringandsuppliesthecremastermuscle.

Ⅶ.Inguinalregion

Ⅰ)Boundaries

1.Inguinalligament

2.Lateralmarginofrectusabdominis

3.Ahorizontallinestretchingfromanterioriliacspinetolateralmarginofrectusabdominis

Ⅱ)Inguinalcanal

1.Boundaries

(1)Anteriorwall

1)Aponeurosisofobliquusexternusabdominis

2)Obliquusinternusabdominis(lateralthirdofwall)

(2)Posteriorwall

1)Transversefascia

2)Inguinalflaxmedially

(3)Roof－archingfibersofobliquusinternusandtransversusabdominis

(4)Floor－inguinalligament

(5)Twoopenings

1)Superficialinguinalring－atriangular-shapeddefectintheaponeurosisoftheobliquusexternusabdominisandliesimmediatelyaboveandmedialtothepubictubercle

2)Deepinguinalring－anovalopeningintransversefasciaandliesapproximately1.5cmabovemidpointofinguinalligament

2.Mechanicsoftheinguinalcanal

(1)Theinguinalcanalisasiteofpotentialweaknessinbothsexes.

(2)Oncoughingandstraining(asinmicturition,defecation,andparturition),thearchinglowersfibersoftheobliquusinternusandtransversusabdominiscontractandflattenthearch.

(3)Inturn,thislowerstheroofofthecanaltowardthefloorandvirtuallyclosesthecanal.

3.Structurespassingthroughtheinguinalcanal

(1)Spermaticcordandilioinguinalnerveinmales

(2)Roundligamentofuterusandilioinguinalnerveinfemales

Ⅲ)InguinalTriangle(ofHesselbach)－boundaries

1.Medially:Lateralborderofrectusabdominis

2.Laterally:Inferiorepigastricartery

3.Inferiorly:Inguinalligament

SupracolicCompartment

LearningObjiective

1.Knowtheconceptofperitoneumandperitonealcavity.

2.Mastertheboundariesofomentalbursaandomentalforamen.

3.Knowthepositionofsupracolicandinfracoliccompartments.

4.Masterthelocation,ligamentsandrelationsofthestomach.Masterthebloodsupplyofthestomach.Knowthelymphdrainageandnervesupplyofthestomach.

5.Masterthelocation,partsandstructuresofduodenum.Knowtherelationsoftheduodenum.

6.Mastertheshape,location,surfacemarkingsandimportantrelationsoftheliver.Masterthecompositionandorderofhepaticpedicle.Knowtheperitonealligamentofthelive.

7.Masterthelocation,partsofgallbladder.Masterthesurfacemarkingsofthefundusofgallbladder.

8.Mastertheboundariesandcontentsofcystohepatictriangle.

9.Knowdivisionsandrelationsofcommonbileduct.

10.Mastertheshape,parts,locationandvertebrallevelsofthepancreas.Knowtherelationsofthepancreas.

11.Masterthelocation,shapeandsurfacemarkingofthespleen.Knowtherelationsofthespleen.Knowtheperitonealligamentofthespleen.

Keystone

1.Theboundariesofomentalbursaandomentalforamen.

2.Thelocation,ligaments,relationsandbloodsupplyofthestomach.

3.Theshape,location,surfacemarkingsandimportantrelationsoftheliver.

4.Thedivisionsandrelationsofcommonbileduct.

5.Therelationsofthepancreas.

QuestionsRequiringShortAnswer

1.Describetheboundariesofomentalbursaandomentalforamen.

2.Describethelocation,ligamentsandrelationsofthestomach.

3.Describethebloodsupplyofthestomach.

4.Describethelocation,partsandstructuresofduodenum.Knowtherelationsoftheduodenum.

5.Describetheshape,location,surfacemarkingsandimportantrelationsoftheliver.

6.Describethecompositionandorderofhepaticpedicle.

7.Describetheboundariesandcontentsofcystohepatictriangle.

8.Describedivisionsandrelationsofcommonbileduct.

ReadingandComprehension

Section3Peritonealcavity

Subdivisions

Thetransversecolonandtransversemesocolondividesthegreatersacinto:

1.Supracoliccompartment（subphrenicspace）－liesbetweendiaphragmandtransversecolonandtransversemesocolon

2.Infracoliccompartment－liesbetweentransversecolonandtransversemesocolonandpelvicinlet

Supracoliccompartment

Generalfeatures:relationshipsofabdominalviscera

Firstlayer－live,gallbladder,stomach

Secondlayer－duodenum,pancreas,spleen

Thirdlayer－suprarenalgland,kidney,ureter,inferiorvenacava,abdominalaorta,nervesandlymphatics

Ⅰ.Stomach

Ⅰ)Relationsofthestomach

1.Anteriorly:

(1)Live(rightpart)

(2)Diaphragm(leftupperpart)

(3)Anteriorabdominalwall(leftlowerpart)

2.Posteriorly:separatedbyperitoneumoflessersacfromthefollowing(stomach-bed)

(1)Pancreas

(2)Leftsuprarenalgland

(3)Leftkidney

(4)Spleen

(5)Transversecolonandtransversemesocolon

Ⅱ)Arteriesofstomach

1.Leftandrightgastricarteries

(1)Arisefromceliactrunkandproperhepaticartery,respectively.

(2)Thesetwovesselsruninlesseromentumalonglessercurvature,andanastomoseend-to-end.

2.Rightandleftgastroepiploicarteries

(3)Arisefromthegastroduodenalandsplenicartery,respectively.

(4)Thesetwovesselspassintothegreateromentum,runparalleltothegreatercurvature,andanastomoseend-to-end.

3.Shortgastricarteries,

(1)Branchesofsplenicartery

(2)Coursethroughthegastrosplenicligament

(3)Supplythefundusofstomach.

4.Posteriorgastricartery(72%)

(1)Arisefromthesplenicartery

(2)Coursethroughthegastrophrenicligamentandsupplytheposteriorwalloffundusofstomach.

Ⅲ)Venousdrainageofstomach

1.Rightandleftgastricveinsemptydirectlyintohepaticportalvein.

2.Leftgastroepiploicandshortgastricveinsdrainintohepaticportalveinviathesplenicvein.

3.Rightgastroepiploicveindrainintosuperiormesentericvein.

Ⅳ)Lymphaticsofstomach

1.Rightandleftgastricln.liealongthesamevesselsandfinallytotheceliacln.

2.Rightandleftgastroomentalln.liealongthesamevessels,theformerdrainintosubpyloricln.,thelatterdrainintosplenicln.

3.Suprapyloricandsubpyloricln.receivelymphaticsfrompyloricpartandfinallytotheceliacln.

4.Splenicln.receivelymphaticsfromfundusandleftthirdofstomach,andfinallytotheceliacln.

Ⅴ)Nervesupplyofstomach

1.Parasympatheticinnervation

(1)Byanterior(left)andposterior(right)vagaltrunks

1)Theanteriortrunkdividesintoanteriorgastricandhepaticbranches

2)Theposteriortrunkdividesintoposteriorgastricandceliacbranches

3)Theanteriorandposteriorgastricbranchesdescendontheanteriorandposteriorsurfacesofthestomachasaruleabout1to2cmfromthelessercurvatureandparalleltoitinthelesseromentumasfarasthepyloricantrumtofanoutintobranchescalled“crow’sfoot”tosupplythepyloricpart

2.Sympatheticinnervation

1)Mainlyfromceliacganglia

2)Afferentandefferentfibersderivesfromthoracicsegments(T5－L1)

Ⅱ.Duodenum

Ⅰ)Relationsofduodenum

1.Relationsofsuperiorpartofduodenum

(1)Anteriorly

1)Quadratelobeoflive

2)Gallbladder

(2)Posteriorly

1)Commonbileduct

2)Gastroduodenala.

3)Hepaticportalv.

4)Inferiorvenacava

(3)Superioely－omentalforamen

(4)Inferiorly－h(huán)eadofpancreas

2.Relationsofdescendingpart

(1)Anteriorly

1)Liver

2)Transversecolonandtransversemesocolon

3)Loopsofsmallintestine

(2)Posteriorly

1)Rightrenalhilumandureter

2)Rightrenalvessels

(3)Medially

1)Headofpancreas

2)Commonbileductandpancreaticduct

(4)Laterally－rightcolicflexure

3.Relationsofhorizontalpart

(1)Superiorly－h(huán)eadofpancreas

(2)Inferiorly－loopsofsmallintestine

(3)Anteriorly

1)Radixofmesentery

2)Superiormesenterica.andv.

(4)Posteriorly

1)Rightureter

2)Inferiorvenacava

3)Abdominalaorta

4.Relationsofascendingpart

(1)Right—headofpancreasandabdominalaorta

(2)Left—leftkidneyandureter

Ⅱ)Bloodsupplyofduodenum

1.Arteries

(1)Superiorpancreaticoduodenala.

(2)Inferiorpancreaticoduodenala.

2.Veins－followarteries,drainingdirectlyintosuperiormesentericandhepaticportalveins

Ⅲ.Relationsofliver

Ⅰ)Diaphragmaticsurface－separatedbydiaphragmfromthefollowing

1.Rightcostodiaphramaticrecessandlung

2.Cardiacbase

Ⅱ)Visceralsurface

1.Leftlobeisrelatedtothestomachandabdominalpartofesophagus

2.Rightlobeisrelatedtotherightcolicflexureanterioly,gallbladderandsuperiorduodenalflexuremedially,rightkidney,superarenalglandposteriorly

Ⅳ.Commonbileduct

Ⅰ)Divisionsofcommonbileduct

1.Supraduodenalsegment

2.Retroduodenalsegment

3.Pancreaticsegment

4.Intraduodenalsegment

Ⅱ)Relationsofcommonbileduct

1.Supraduodenalsegment

(1)Descendsalongtherightmarginofhepatoduodenallig.

(2)Totherightofproperhepatica.

(3)Anteriortohepaticportalv.

2.Retroduodenalsegment

(1)Behindthesuperiorpartofduodenum

(2)Anteriortothevenacava

(3)Totherightofthehepaticportalv.

3.Pancreaticsegment

(1)Liesinagroovebetweenposteriorsurfaceofheadofpancreasandduodenum

(2)Intraduodenalsegment

(3)Entersthewallofdescendingpartofduodenumobliquelywherejionsthepancreaticducttoformthehepatopancreaticampulla

(4)Opensatthemajorduodenalpapilla

Ⅲ)Cystohepatictriangle

1.Boundaries(Calot’sTriangle)

(1)Commonhepaticductontheleft

(2)Cysticductontheright

(3)Liversuperiorly

2.Content:cysticartery

Ⅴ.ThePancreas

Ⅰ)Fourparts

1.Head

(1)DiscshapedandlieswithinthecancavityoftheC-shapedcurvatuneofduodenum

(2)Uncinateprocess－aprojectiontotheleftfromthelowerpartoftheheadbehindthesuperiormesentericvessels.

2.Neck－narrowpart,overliesthesuperiormesentericvesselsandbeginningoftheportalvein

3.Body－triangularincrosssection,passesupwardandtotheleftacrossthemidline

4.Tail－extendstothehilumofspleeninthesplenorenalligament

Ⅱ)Relationsofpancreas

1.Headofpancreas－locatedinC-shapescurvatureofdoudenum

(1)Anteriorly－transversemesocolon

(2)Posteriorly

1)Inferiorvenacava

2)Rightrenalvessels

3)Commonbileduct

2.Neckofpancreas

(1)Anteriorly－pylorus

(2)Posteriorly－beginningofhepaticportalv.

3.Bodyofpancreas

(1)Anteriorly－separatedfromstomachbyomentalbursa

(2)Posteriorly

1)Abdominalaorta

2)Leftsuprarenalgland

3)Leftkidney

4)Leftrenalvessels

5)Spleenvein

(2)Superiorly

1)Celiactrunk

2)Celiacplexus

3)Splenica.

4.Tailofpancreeas

(1)Runsinsplenorenalligamenttoreachhilumofspleen

(2)Accompanieswithsplenicvessels

Ⅵ.Relationsofspleen

Ⅰ)Diaphragmaticsurface－diaphragm

Ⅱ)Visceralsurface

1.Anteriorly－fundusofstomach

2.Posteriorly－leftsuprarenalglandandkidney

3.Inferiorly－tailofpancreasandleftcolicflexure

InfracolicCompartment

LearningObjiective

1.Knowthedifferencesbetweenjejunumandileum.Knowthebloodsupplyandlymphaticdrainageofjejunumandileum

2.Knowthepositionofmesenterictriangle.

3.Masterthedispositionandsurfaceanatomyofthecaecum,ascendingcolon,transversecolon,descendingcolonandsigmoidcolon.

4.Masterthesurfacemarkingofthebaseofvermiformappendix.Knowthevariouspositionsoftheappendix.

5.Masterthebloodsupplyofthecolonandtheimportanceofthemarginalartery.

6.Knowthelymphaticdrainageofcolon.

7.Mastertheformationandtributariesofhepaticportalvein.Mastertheimportantsizeofportal-systemicanastomoses.

Keystone

1.Thedispositionandsurfaceanatomyofthecaecum,ascendingcolon,transversecolon,descendingcolonandsigmoidcolon.

2.Thebloodsupplyofthecolonandtheimportanceofthemarginalartery.

3.Theformationandtributariesofhepaticportalvein.Mastertheimportantsizeofportal-systemicanastomoses.

QuestionsRequiringShortAnswer

1.Describethedispositionandsurfaceanatomyofthecaecum,ascendingcolon,transversecolon,descendingcolonandsigmoidcolon.

2.Describethesurfacemarkingofthebaseofvermiformappendix.

3.Describethebloodsupplyofthecolonandtheimportanceofthemarginalartery.

4.Describetheformationandtributariesofhepaticportalvein.

5.Describetheimportantsizeofportal-systemicanastomoses.

ReadingandComprehension

Ⅰ.Jejunumandileum:

Ⅰ)DifferencesBetweenJejunumandileum

Characteristic

Jejunum

Ileum

Position

Upper2/5,upperleftpartofabdominalcavity

Lower3/5,lowerrightpartofabdominalcavity

Diameter

Greater

Less

Wall

Thicker

Thin

Circularfolds

Largerspiralmucosalfolds,numerousandlargevilli

Fewermucosalfolds;smallerandlessabundantvilli

Vascularity

Greater

Less

Vasarecta

Long

Short

Color

Deeperred

Palerpink

Lymphaticfollicles

Solitary

Aggregated

Fatinmesentery

Less

More

Ⅱ)Rootofmesentery

1)15cmlong

2)DirectedobliquelyfromleftsideofL2toinfrontofrightsacroiliacjoint

3)Crossesfromaboveanddownwardthefollowingstructures:

a)Horizontalpartofduodenum

b)Aorta

c)Inferiorvenacava

d)Rightureter

e)Rightpsoasmuscle

Ⅱ.Cecum

Ⅰ)Liesinrightiliacfossa

Ⅱ)Blindsac,firstpartoflargeintestine,withlargestdiameterandthinnestwall

Ⅲ)Theileumentersthececumobliquely,andpartiallyinvaginatesintoit,formingtheileocecalvalve－consistsoftwofolds,probablydelaysflowofilealcontentsintolargeintestine

Ⅲ.Vermiformappendix

Ⅰ)Blindworm-liketube,6－8cmlong,about0.5cmindiameter

Ⅱ)Opensintoposteromedialaspectofcecum，about2cmbelowileocealorifice

Ⅲ)Internally,thebaseoftheappendixliesatthepointofconvergenceofthreecolicbands(usedasaguidetofindtheappendixduringoperation)

Ⅳ)Surfacemarkingofthebaseisattheso-calledMcBurney’spointwhichisatthejunctionoflateralandmiddlethirdsoflinejoiningrightanteriorsuperioriliacspineandumbilicus

Ⅴ)Tipvariableinposition

1.Retrocecalandretrocolic－65%

2.Pelvic－31%

3.Subcecal,preileal,andretroileal－4%

Ⅵ)Mesoappendix

1.Triangularmesentery－extendsfromterminalpartofileumtoappendix

2.Appendicularartery,aterminalbranchofiliocolicartery

(1)Runsinfreemarginofthemeseoappendixthenalongwallofappendix

(2)Solebloodsupplyofappendixandmustbeligatedinappendectomy

Ⅳ.Colon－formsthelongestpartoflargeintestine,itissubdividedintofourparts

Ⅰ)Ascendingcolon－extendsformcecum,inrightiliacfossa,upwardtoundersurfaceofrightlobeofliverwhereitturnssharplytotheleftformingtherightcolicflexureandbecomescontinuouswiththetransversecolon.

Ⅱ)Transversecolon

1.Extendsfromrighttoleftcolicflexureandcrossestheabdominalcavity

2.Suspendedbylongtransversemesocolon

Ⅲ)Descendingcolon－descendsalmostverticallyfromleftcolicflexuretosigmoidcolonatleftiliaccrest.

Ⅳ)Sigmoidcolon－extendsfromdescendingcolontorectumatlevelofS3.

Ⅴ.Thebloodsupplyofthecolonandtheimportanceofthemarginalartery

Superiormesentericartery－arisesfromthefrontofaorta,atthelevelofL2

Inferiorpancresticodudenalartery

Jejunalandilealarteries(12-16)

BranchesIleocolicartery→appendicularartery

Rightcolicartery

Middlecolicartery

3)Inferiormesentericartery－arisesfromthefrontofaorta,atlevelofL3

Leftcolicartery

BranchesSigmoidarteries

Superiorrectalartery

Ⅵ.Hepaticportalvein

1.Generalfeatures

(1)Formedbehindtheneckofpancreasbytheunionofsuperiormesentericveinandsplenicvein

(2)Ascendsupwardsandtotheright,posteriortothefirstpartofduodenumandthenentersthelesseromentumtotheportahepatis,whereitdividesintorightandleftbranches

(3)Therearenofunctioningvalvesinhepaticportalsystem

(4)Drainsbloodfromgastrointestinaltractfromthelowerendofoesophagustotheupperendofanalcanal,pancreas,gallbladder,bileductsandspleen

2.Tributariesofhepaticportalvein

(1)Superiormesentericvein

(2)Inferiormesentericvein

(3)Splenicvein

(4)Leftgastricvein

(5)Rightgastricvein

(6)Cysticvein

(7)Paraumbilicalveins

3.Portosystemicanastomoses

(1)Theportal-azygosanastomosis:atthelowerendoftheoesophagus

hepaticportalvein→leftgastricvein→esophagealvenousplexus→esophagealvein→azygosvein→superiorvenacava

(2)Theportal-rectalanastomosis

hepaticportalvein→splenicvein→inferiormesentericvein→superiorrectalvein→rectalvenousplexus→inferiorrectalandanalveins→internaliliacvein→inferiorvenacava

(3)Portal-umbilicalanastomosis

hepaticportalvein→paraumbilicalvein→periumbilicalvenousrete→

1)thoracoepigastricandsuperiorepigastricvein→superiorvenacava

2)superficialepigastricandinferiorepigastricveins→inferiorvenacava

(4)Portal-retroperitonealanastomosisbetweentheretroperitonealbranchesofthecolicveinsandthelumbarveins,pancreaticoduodenalveinswiththerenalveinsandthesubcapsularveinsoftheliverwiththephrenicveins,twigsofcolicveins(portal)anastomosingwithsystemicretroperitonealveins

Retroperitonealspace

LearningObjiective

1.Knowtheboundariesandcontentsofretroperitonealspace.

2.Masterthelocation,generalfeaturesandsurfacemarkingofthekidney.Masterthecompositionandorderofrenalpedicle.Knowtheconceptofrenalsegments.Knowthecoveringsofthekidney.Mastertheimportantrelationsofthekidneys.Knowthelymphaticdrainageofkidney.

3.Knowthelocationandgeneralfeaturesofsuprarenalglands.

4.Knowthecourseandrelationsofureterintheabdomen.Masterthesitesofnarrowingofureter.

5.Mastertherelationsandvisceralbranchesoftheabdominalaortaandtheirterritory.

6.Masterthelocationandmaintributariesofinferiorvenacava.

7.Knowthelymphnodesoftheabdomen.

8.Knowtheformation,positionandmainbranchesofthelumberplexuses.

9.Knowthelocationsoflumbersympathetictrunks.

Keystone

1.Theboundariesandcontentsofretroperitonealspace.

2.Theimportantrelationsofthekidneys.

3.Therelationstheabdominalaorta.

4.Thelocationandmaintributariesofinferiorvenacava.

QuestionsRequiringShortAnswer

1.Describethelocation,generalfeaturesandsurfacemarkingofthekidney.

2.Describethecompositionandorderofrenalpedicle.

3.Describetheimportantrelationsofthekidneys.

4.Describetherelationsandvisceralbranchesoftheabdominalaortaandtheirterritory.

5.Describethelocationandmaintributariesofinferiorvenacava.

ReadingandComprehension

Retroperitonealspace

Ⅰ.Position－itliesbetweentheparietalperitoneumandtransversfasciaoftheposteriorabdominalwall,fromdiaphragmtopromontoryofsacrum,continuationwithextraperitonealfascia.

Ⅱ.Contents

1.Kidney

2.Suprarenalgland

3.Ureter

4.Abdominalaorta

5.Inferiorvenacava

6.Nervesandlymphatic

7.Looseconnectivetissue

Ⅲ)Suprarenalgland

1.Shapeandposition

(1)Rightispyramidalinshape,leftonesemilunarinshape,consistingofoutcortexandinnermedulla

(2)Locatedretroperitoneally,superomedialtosuperiorpolesofeachkidney,enclosewiththekidneybytherenalfascia

2.Bloodsupply

(1)Arteries

1)Superiorsuprarenala.

2)Middlesuprarenala.

3)Inferiorsuprarenala.

VesselsandLymphoftheAbdomen

I.Abdominalaorta

I)Continuationofthoracicaortaataortichiatusofdia