腹部解剖图谱PPT课件

1、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 第1页/共83页Superficial fasciadivisions below umbilicusSuperficial fatty layer (Campers)Membranous layer (Scarpas)第2页/共83页 Muscles of a

2、bdomenAnterolateral groupObliquus externus absominis 腹外斜肌Oblequus enternus abdominis腹内斜肌Transversus abdominis腹横肌Rectus abdominis 腹直肌第3页/共83页Posterior group Quadiatus lumborum 腰方肌Psoas major 腰大肌第4页/共83页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第5页/共83页第6页/共83页Obliquus internus abdominis 腹内斜肌腹内斜肌Deep to obliquus externus abdominisGeneral direction

4、of fibres: upwards, forwards and medially第7页/共83页Transversels abdominis 腹横肌腹横肌Deep to obliquus internus 第8页/共83页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第9页/共83页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 腱划linea semiluaris 半月线 第10页/共83页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页/共83页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页/共83页Linea alba 白线tendinous raphe between right and left recti from xiphoid to pubic symphysis.第13页/共83页Inguinal region 腹股沟区腹股沟区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页/共83页Descent of testesSeven-week embryo showing the testis before its descent from the dorsal abdominal wall第15页/共83页Fetus at 28 week the testis passing through the ing

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

11、 Inguinal flax mediallyRoofarched lower fibers of obliquus internus and transversua abdominisFlooringuinal lig第20页/共83页Two openingsSuperficial inguinal ring 腹股沟浅环Deep inguinal ring 腹股沟深环 defect in transverse fascia 1.5cm above midpoint of inguinal ligament第21页/共83页Structures passing through the ingu

12、inal 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 第22页/共83页Inguinal Triangle (of Hesselbach) 腹股沟腹股沟三角三角 Boundaries Inguinal ligament inferiorlyLateral border of rectus abdominis medially Inferior epigastric artery

13、 laterally第23页/共83页Indirect inguinal heinia and direcet inguinal heinia 第24页/共83页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页/共83页Deep vessels and nervesArteres Superior and inferior epigastric arterisLower posterior intercostal a.Subcostal a.Four lumbar a. 第26页/共83页Nerves Iliohypogastric n. 髂腹下神经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. 髂腹股沟神经Runs parallel with iliohypogastric n. at a lower levelEnters inguinal cana

16、l and emerges through superficial inguinal ringGenitofemoral n. 生殖股神经第27页/共83页Subcostal incision Muscle-splitting incisionTransverse incision Median or midline incisionLeft paramedian incisionSuprapubic incision第28页/共83页Abdomen 2山 东 大 学 医 学 院山 东 大 学 医 学 院 解 剖 教 研 室解 剖 教 研 室李 振 华李 振 华第29页/共83页Abdomin

17、al aorta 腹主动脉腹主动脉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页/共83页Parietal branchesInferior phrenic a. 膈下动脉(one pair)Lumbar a. 腰动脉(four pairs of arteries that supply t

18、he posterior abdominal wall)Median sacral a. 骶正中动脉第31页/共83页Visceral branches Paired branches Middle suprarenal artery 肾上腺中动脉Renal artery 肾动脉Testicular (ovarian) artery 睾丸（卵巢）动脉第32页/共83页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. 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第33页/共83页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页/共83页Celiac trunk 第35页/共83页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页/共83页Infe

21、rior mesenteric a.Left colic a.Sigmoid a.Superior rectal a. Inferior mesenteric v.第37页/共83页Colic marginal artery第38页/共83页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页/共83页Veins of abdomen and pelvisInternal iliac vein 髂内静脉 Parietal tributaries: accompany with arteries Visceral tributaries superior rectal veininferior mesenteric v.Rectal venous plexus inferior rectal veininternal iliac v.直肠静脉丛 anal veininternal pudenda

23、l v. Vesical venous plexus 膀胱静脉丛vesical v.Uterine venous plexus 子宫静脉丛uterine v. 第40页/共83页 External iliac vein 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 c

24、ava第41页/共83页Inferior vena cava 下腔静脉下腔静脉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页/共83页Chief tributariesParietalPaired inferior phrenic v. 膈下静脉paired lumbar v. 腰静脉 (four)VisceralRight and left 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 vein

26、s 肝静脉: right, left and intermediate第43页/共83页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页/共83页Hepatic portal vein 肝门静脉肝门静脉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页/共83页Variation and anomalies of hepatic portal vein第46页/共83页Tributaries of hepatic portal vein 1. Superior mesenteric v. 肠系膜上静脉2. Inferior 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. Paraumbili

30、cal v. 附脐静脉第47页/共83页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页/共83页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页/共83页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页/共83页Lymphatic drainage o

34、f 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 and left lumbar trunks formed by efferent vesselPaired visce

35、radrain to the lumbar lymph nodes第51页/共83页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 mesenteric a. Intestinal trunk 腹腔干 formed by efferent vess

36、el of celiac, superior and inferior lymph nodes第52页/共83页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 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页/共83页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页/共83页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 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页/共83页Ralationships

41、of spleenDiaphragmatic surfacediaphragmVisceral surfaceAnteriorlyfundus of stomachPosteriorlyleft suprarenal gland and kidneyInferiorlytail of pancreas and left colic flexure 第56页/共83页Nervers of abdomen Lumbar plexus 腰丛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页/共83页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Genitofemor

43、al n. 生殖股神经第58页/共83页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页/共83页Abdomen 3山 东 大 学 医 学 院山 东 大 学 医 学 院 解 剖 教 研 室解 剖 教 研 室李 振 华李 振 华第60页/共83页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页/共83页 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页/共83页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页/共83页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页/共83页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页/共83页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页/共83页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页/共83页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页/共83页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页/共83页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页/共83页Relationships of ascending partRight Head of pancreas and abdominal aortaLeft Left kidney and ureter第71页/共83页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页/共83页Blood supply Arteries Superior pancreaticoduodenal a.Inferior pancreaticoduodenal a.Veinsfollow arteries, draining directly into superior mesenteric and hepatic portal veins 第73页/共83页Divisions and relations of common bile ductSupraduodenal segment Descends alon