《腹部解剖图谱》PPT课件.ppt

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1、Abdominal wall,山东大学医学院 解剖教研室李振华,Anterior wall,Layers(from superficial to deep)Skin Superficial fasciaAnterolateral musclesTransversalis fascia 腹横筋膜Extraperitoneal fascia 腹膜下筋膜Parietal peritoneum 壁腹膜,Superficial fasciadivisions below umbilicusSuperficial fatty layer(Campers)Membranous layer(Scarpas),

2、Muscles of abdomen,Anterolateral groupObliquus externus absominis 腹外斜肌Oblequus enternus abdominis腹内斜肌Transversus abdominis腹横肌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 medially(run down

3、and inward)StructuresInguinal ligament 腹股沟韧带Lacunar ligament 腔隙韧带Superficial inguinal ring 腹股沟浅环 triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle,Obliquus internus abdominis 腹内斜肌,Deep to obliquus externus abdominisGeneral direction of fibres:upwards,forward

4、s and medially,Transversels abdominis 腹横肌,Deep to obliquus internus,Inguinal falx 腹股沟镰:arch over spermatic cord,inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睾肌:around the spermatic cord and testis,Rectus abdominis 腹直肌,Position:lie on to either of midlineOr

5、igin:pubic crest and symphysisInsertion:xiphoid and 5th-7th costal cartilagesHas 3-4 tendinous intersections 腱划linea semiluaris 半月线,Similar functions for above four pairs of muscles,Support and compress the abdominal visceraIncrease intra-abdominal pressure,aid in expulsive efforts-vomiting,coughing

6、,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 and anterior leaf of aponeurosis of obliquus intern

7、us 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 all three muscles form anterior layer the lower free border named arcuate lineBelow this line

8、rectus abdominis in contact with transverse fascia,Linea alba 白线tendinous raphe between right and left recti from xiphoid to pubic symphysis.,Inguinal region 腹股沟区,Boundaries Inguinal ligament Lateral margin of rectus abdominisA horizontal line stretching from anterior iliac spine to laeral margin of

9、 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 腹股沟管,Position:oblique passage,4cm long,located 1.5cm above medial half of inguinal lig.,Bou

10、ndariesAnt wallAponeurosis of obliquus externus abdominisObliquus internus abdominis(lateral third of wall),Post wallTransverse fascia Inguinal flax mediallyRoofarched lower fibers of obliquus internus and transversua abdominisFlooringuinal lig,Two openingsSuperficial inguinal ring 腹股沟浅环Deep inguina

11、l ring 腹股沟深环 defect in transverse fascia 1.5cm above midpoint of inguinal ligament,Structures passing through the inguinal canal Spermatic cord 精索 and ilioinguinal nerve髂腹股沟神经 in males Round ligament of uterus 子宫圆韧带and ilioinguinal nerve髂腹股沟神经 in females,Inguinal Triangle(of Hesselbach)腹股沟三角,Boundar

12、ies Inguinal ligament inferiorlyLateral border of rectus abdominis medially Inferior epigastric artery laterally,Indirect inguinal heinia and direcet inguinal heinia,Superficial vessels and cutaneous nerves,Arteries Superficial epigastric a.Superficial iliac circumflex a.Veins Thoracoepigastric v.Su

13、perficial epigastric v.Cutaneous nervesAnterior and lateral cutaneous n.of lower six thoracic Iliohypogastric n.(first lumb nerves),Deep vessels and nerves,Arteres Superior and inferior epigastric arterisLower posterior intercostal a.Subcostal a.Four lumbar a.,Nerves Iliohypogastric n.髂腹下神经Arises fr

14、om lubar plexusPasses forward in the interval between obliquus internus 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.髂腹股沟神经Runs para

15、llel with iliohypogastric n.at a lower levelEnters inguinal canal and emerges through superficial inguinal ringGenitofemoral n.生殖股神经,Layer?,Abdomen 2,山东大学医学院 解剖教研室李振华,Abdominal aorta 腹主动脉,Continuation of thoracic aorta at aortic hiatus of diaphragm in front of T12 Terminates at lower border of L4 ve

16、rtebra by dividing into right and left common iliac arteries,Parietal branchesInferior phrenic a.膈下动脉(one pair)Lumbar a.腰动脉(four pairs of arteries that supply the posterior abdominal wall)Median sacral a.骶正中动脉,Visceral branches Paired branches Middle suprarenal artery 肾上腺中动脉Renal artery 肾动脉Testicula

17、r(ovarian)artery 睾丸（卵巢）动脉,Unpaired branches Celiac trunk 腹腔干 a short thick vessel that arises from the front of aorta,at the level of T12Superior mesenteric a.肠系膜上动脉arises from the front of aorta,at the level of L2Inferior mesenteric a.肠系膜下动脉 arises from the front of aorta,at level of L3,Celiac trun

18、k,Celiac trunk,Colic marginal artery,Relations of abdominal aortaAnteriorly(from above downward)Pancreas Ascending part of duodenum Radix of mesenteryPosteriorly Upper four lumber vertebrae On its right Inferior vena cavaOn its left Left sympathetic trunk,Veins of abdomen and pelvis,Internal iliac v

19、ein 髂内静脉Parietal tributaries:accompany with arteriesVisceral tributaries superior rectal veininferior mesenteric v.Rectal venous plexus inferior rectal veininternal iliac v.直肠静脉丛 anal veininternal pudendal v.Vesical venous plexus 膀胱静脉丛vesical v.Uterine venous plexus 子宫静脉丛uterine v.,External iliac ve

20、in 髂外静脉 accompany the arteryCommon iliac vein 髂总静脉 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 cava,Inferior vena cava 下腔静脉,Formed by union of two common iliac veins anterior to and just to the right of L

21、4L5Ascends 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 to the right atrium,Chief tributariesParietalPaired inferior phrenic v.膈下静脉paired lumbar v.腰静脉(four)VisceralRight and lef

22、t renal veins 左、右肾静脉Right suprarenal vein 右肾上腺静脉(left drain into left renal vein)Right testicular or ovarian v右睾丸（卵巢）静脉.(left drain into left renal vein)Hepatic veins 肝静脉:right,left and intermediate,Relations of inferior vena cavaAnteriorly(cranially to caudally)LiverHead of pancreasHorizontal part

23、of duodenumRight testicular(or ovarian)a.Radix of mesenteryPosteriorly Right crus of diaphragmUpper four lumber vertebraeLeft sympathetic trunkParietal branches of abdominal aorta On its right Psoas majorRight kidneyRight suprarenal glandOn its left Abdominal aorta,Hepatic portal vein 肝门静脉,General f

24、eaturesFormed behind the neck of pancreas by the union of superior mesenteric vein and splenic vein Ascends upwards and to the right,posterior 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

25、valves in hepatic portal system Drains blood from gastrointestinal tract from the lower end of oesophagus to the upper end of anal canal,pancreas,gall bladder,bile ducts and spleen,Variation and anomalies of hepatic portal vein,Tributaries of hepatic portal vein 1.Superior mesenteric v.肠系膜上静脉2.Infer

26、ior mesenteric v.肠系膜下静脉3.Splenic v.脾静脉4.Left gastric v.胃左静脉5.Right gastric v.胃右静脉6.Cystic v.胆囊静脉7.Paraumbilical v.附脐静脉,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 rect

27、al venous plexus Hepatic portal vein splenic vein inferior mesenteric vein superior rectal vein rectal venous plexus inferior rectal and anal veins internal iliac vein inferior vena cava3.At periumbilical venous plexus Hepatic portal veinparaumbilical veinperiumbilical venous plexusthoracoepigastric

28、 and superior epigastric vein superiorvena cavasuperficial epigastric and inferior epigastric veins inferior 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

29、veins of the liver with the phrenic veins twigs of colic veins(portal)anastomosing with systemic retroperitoneal veins,The lymphatic drainage of abdomen,Lymphatic drainage of abdominal wallTo axillary lymph node from region above umbilicusTo superficial inguinal lymph node from region below umbilicu

30、sTo lumbar lymph node from post wall of abdomen,Lymphatic drainage of abdominal visceraLumbar lymph nodes 腰淋巴结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

31、 and left lumbar trunks formed by efferent vesselPaired visceradrain to the lumbar lymph nodes,Celiac lymph nodes 腹腔淋巴结 situated around the celiac trunk Superior mesenteric lymph node 肠系膜上淋巴结 situated around superior mesenteric a.Inferior mesenteric lymph node 肠系膜下淋巴结 situated around inferior mesent

32、eric a.Intestinal trunk 腹腔干 formed by efferent vessel of celiac,superior and inferior lymph nodes,Thoracic duct 胸导管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

33、 hiatus of the diaphragm and ascends along 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

34、,it receives the left jugular,subclavian 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,Spleen 脾,Location:lies in the left hypochondriac region(between stomach and diaphragm)deep to the

35、9th to 11th rib,its long axis corresponds roughly to the 10th ribShapereddish in colour,Two surfaces Diaphragmatic:smooth,convexVisceral:concave,hilum of spleenTwo extremities AnteriorwiderPosteriorrounderTwo border Superiorhas 2-3 splenic notch 脾切迹,which serve as a landmark on palpation when it is

36、enlarge;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,Ralationships of spl

37、eenDiaphragmatic surfacediaphragmVisceral surfaceAnteriorlyfundus of stomachPosteriorlyleft suprarenal gland and kidneyInferiorlytail of pancreas and left colic flexure,Nervers of abdomen,Lumbar plexus 腰丛Formation:formed by anterior rami of L1-L3,a part of anterior rami of T12and L4Position:lies wit

38、hin substance of psoas major,Branches Iliohypogastric n.髂腹下神经Supplies lower part of anterior abdominal wallIlioinguinal n.髂腹股沟神经Passes through inguinal canal to supply skin of the groin and scrotum Lateral femoral cutaneous 股外侧皮神经Femoral n.股神经Obturator n.闭孔神经Genitofemoral n.生殖股神经,Lumbar sympathetic

39、trunk 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 unpaired ganglion impar,anterior to sacrum

40、,Abdomen 3,山东大学医学院 解剖教研室李振华,Relationships of abdominal viscera,First layerlive,gallbladder,stomach Second layerduodenum,pancreas,spleenThird layersuprarenal gland,kidney,ureter,inferior vena cava,abdominal aorta,nerves and lymphatics,Relationships of the stomach,Anterior:Live(right part)Diaphragm(le

41、ft upper part)Anterior abdominal wall(left lower part)Posteriorseparated by peritonum of lesser sac from the following(“stumach-bed”)Pancreas Left suprarenal glandLeft kidneySpleen Transverse colon and transvers mesoclon,Arteries of stomach,Left and right gastric arteries arise from celiac trunk and

42、 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 greater

43、 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 posterior wall of fund

44、us of stomach.,Venous drainageRight 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 Right and left gast

45、ric 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 celiac ln.Splenic ln.receive

46、 lymphatics from fundus and left third of stomach,and finally to the celiac ln.,Nerve supplyParasympathetic innervation 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

47、branchesThe 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 called“crows foot”to supply the pyloric

48、 partSympathetic innervationMainly from celiac gangliaAffent and effent fibers derives from thoracic segments(T5 L1,The duodenum,Relationships of superior part AnteriorlyQuadrate lobe of liveGallbladderPosteriorlyCommom bile duct Gastroduodenal a.Hepatic portal v.Inferior vena cavaSuperioely Omental

49、 foramenInferiorly Head of pancreas,Relationships of descending partAnteriorlyLive Transverse colon and mesocolonLoops of small intestine Posteriorly Right renal hilum and ureterRight renal vesselsMediallyHead of pancreasCommon bile duct and pancreatic ductLaterally Right colic flexure,Relationships

50、 of horizontal partSuperiorlyHead of pancreasInferiorly Loops of small intestine AnteriorlyRadix of mesenterySuperior mesenteric a.and v.PosteriorlyRight ureterInferior vena cavaAbdominal aorta,Relationships of ascending partRight Head of pancreas and abdominal aortaLeft Left kidney and ureter,Relat