Abdomen

Abdomen: General description Lies between the diaphragm and the pelvic inlet.

Is the largest cavity in the body and is continuous with the pelvic cavity.

Lined with parietal peritoneum, a serous membrane

Bounded superiorly by the diaphragm

o Has a concave dome

o Spleen, liver, part of the stomach, and part of the kidneys lies under the dome and are protected by the lower ribs and costal cartilages.

Lower extent lies in the greater pelvis

o Between the ala or wings of the ilia

o Ileum, cecum, and sigmoid colon thus partly protected

Anterior and lateral walls composed of muscle

o Viscera in these areas are more likely to be damaged by blunt force and penetrating injuries.

Posterior wall comprised of vertebral column, the lower ribs, and associated muscles

o Protect the abdominal contents. Bony landmarks of the abdomen

Xiphoid process

Lower six costal cartilages

Anterior ends of the lower six ribs (ribs 7 to 12) (Section 3-3: Thorax-Body Wall)

Lumbar vertebrae (L1 to L5)

Pelvis

o Iliac crest

o Anterior superior iliac spine (ASIS)

o Anterior inferior iliac spine

o Pubic symphysis

o Pubic crest and pubic tubercle Abdomen: Topographical anatomy

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page 125 Costal margin: Formed by the medial borders of the 7th through 10th costal cartilages

Rectus sheath

o From xiphoid process and 5th through 7th costal cartilages → pubic symphysis and pubic crest

o Contains rectus abdominis muscle (Section 4-2: Abdomen-Body Wall)

Linea alba

o A slight indentation that can sometimes be seen extending from the xiphoid process to the pubic symphysis

o A fibrous raphe where the aponeuroses of the external and internal abdominal oblique and the transversus abdominis muscles on either side unite.

Semilunar line (linea semilunaris)

o Vertical indentation seen as a curved line from the tip of the ninth rib cartilage to the pubic tubercle on each side in well-muscled individuals

o Represents the lateral edge of the rectus abdominus muscle

Tendinous intersections

o Transverse attachments between the anterior rectus sheath and rectus abdominis muscle

o May be seen as transverse grooves in skin on either side of midline (six-pack)

Inguinal ligament

o From ASIS to pubic tubercle of pelvis

o Folded inferior edge of external abdominal aponeurosis

o Separates abdominal region from thigh

Umbilicus

o At approximate level of intervertebral disc between the L3 and L4

o Marks the T10 dermatome

Liver

o Mainly in the right upper quadrant, behind ribs 7 through 11 on the right side

o Crosses the midline to reach towards the left nipple (Section 4-5: Abdomen-

Viscera (Accessory Organs))

Spleen

o Beneath ribs 9 through 11 on the left side

o 10th rib is axis of spleen

Kidneys

o Located in loin region

o Left kidney is higher than right (pelvis at L1/2 on left and L2/3 on right) (Section 4-8: Abdomen-Kidneys and Suprarenal Glands)

Abdominal contents page 125

page 126 Gastrointestinal tract

o Stomach

o Duodenum

o Ileum

o Jejunum

o Cecum and appendix

o Ascending, transverse and descending colon

o Part of the sigmoid colon

Accessory digestive organs

o Liver

o Gallbladder

o Pancreas

Spleen

Suprarenal glands

Urinary system-kidneys and ureters

o Kidneys are the only organs developing beneath the parietal peritoneum

o Never have a mesentery

o Thus are primarily retroperitoneal

Organs that develop within the abdominal cavity and then become retroperitoneal

o Are called secondarily retroperitoneal

o Pancreas

o Two thirds of the duodenum

o Ascending and descending colon.

All the rest of the organs are peritoneal

o Lie within the peritoneal cavity

o Covered by a layer of visceral peritoneum

o Visceral peritoneum is continuous with the parietal peritoneum lining the cavity via a mesentery.

Abdominal regions Abdominal quadrants

o Clinicians usually divide the abdomen is into four quadrants for descriptive purposes, using the following planes:

Median plane: imaginary vertical line following the line alba from the xiphoid process to the pubic symphysis

Transumbilical plane: imaginary horizontal line at the level of the umbilicus

o These lines or planes create four quadrants

Right upper

Left upper

Right lower

Left lower

Abdominal regions

o Clinicians may divide the abdomen into nine regions

For more accurate descriptive and diagnostic purposes

Use two vertical and three horizontal lines or planes

o Horizontal planes (in descending order):

Subcostal plane: passes through the lower border of the 10th costal cartilage on either side

Sometimes the transpyloric plane is used instead of the subcostal; passes through the pylorus on the right and the tips of the ninth costal cartilage on either side

Transumbilical plane: passes through the umbilicus at the level of the L3/4 intervertebral disc

Transtubercular (intertubercular) plane: passes through the tubercles of the iliac crests and the body of L5

o Vertical planes

Right midclavicular line

Left midclavicular line

Pass from the midpoint of the clavicle to the midpoint of inguinal ligament.

o These planes create nine abdominal regions:

Right and left hypochondriac regions, superiorly on either side

Right and left lumbar (flank) regions, centrally on either side

Right and left inguinal (groin) regions, inferiorly on either side

Epigastric region superiorly and centrally

Umbilical region, with the umbilicus as its center

Hypogastric or suprapubic region, inferiorly and centrally

Descriptive quadrants and regions are essential in clinical practice

o Each area represents certain visceral structures

o Allow correlation of pain and referred pain from these areas to specific organs.

Regions and quadrants are palpated, percussed, and auscultated during clinical examination

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page 127Contents of the Abdominal Quadrants Right Upper Quadrant (RUQ) Left Upper Quadrant (lUQ)Liver (right lobe)Gallbladder

Liver (left lobe)Spleen

Pylorus (of stomach)Duodenum (parts 1 through 3)Pancreas (head)Right kidney and suprarenal glandColon: distal ascending colon, hepatic flexure and right half of transverse colon

StomachJejunum and proximal ileumPancreas (body and tail)Left kidney and suprarenal glandColon: left half of transverse colon, splenic flexure and superior part of descending colon

Right Lower Quadrant (RLQ) Left Lower Quadrant (LLQ)Majority of ileumCecum with vermiform appendixProximal ascending colonProximal right ureter

Distal descending colonSigmoid colonLeft ureter

OvariesUterine tubes

Right and left ductus deferensUterus (if enlarged)

Urinary bladder (if full, especially in women)Peritoneum

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page 139 Serous membrane

o Lines the abdominopelvic cavity

o Consists of two continuous layers of mesothelium:

o Parietal peritoneum

Lines the internal abdominal wall

Receives its neurovascular supply from the region of the wall it lines

o Visceral peritoneum

Invests abdominal viscera

Receives its neurovascular supply from that of organ

Peritoneal cavity

o A potential space between the parietal and visceral layers of the peritoneum

o Contains a thin film of fluid

o No organs actually lie within this potential space

o Males: peritoneal cavity is completely closed

o Females: communicates with exterior of body via uterine tubes, uterus, and

vagina

Intraperitoneal organs

o Are organs nearly totally covered by visceral peritoneum

o Not actually inside the peritoneal cavity, but project into the peritoneal cavity

o Are covered by peritoneum

o Are attached to body wall and other organs by mesenteries and ligaments

o Include:

Liver

Spleen

Stomach

First part of duodenum

Jejunum

Ileum

Transverse colon

Sigmoid colon

Superior rectum

Primarily retroperitoneal organs

o Organs that develop and remain beneath the parietal peritoneum

o Only the kidneys

Secondarily retroperitoneal organs

o Organs that developed with a short mesentery

o Become pushed against parietal peritoneum lining the body wall by growth of other organs, primarily the small intestine.

o Mesentery of organ fuses with parietal peritoneum: fusion fascia

o Peritoneum covers only its anterior surface, hence, secondarily retroperitoneal

o Organ can be freed at its lateral edge, along the plane of the fusion fascia

o Include

Adrenal glands

Pancreas

Parts two through four of the duodenum

Ascending and descending colon Omentum = double-layered fold of peritoneum

Lesser omentum: connects lesser curve of stomach and proximal duodenum to liver

o Passes from the stomach and first part of the duodenum to adjacent organs

o Consists of two parts:

Hepatogastric ligament

Hepatoduodenal ligament

Greater omentum

o Hangs down from the greater curve of the stomach and proximal duodenum

o Folds back on itself to attach to the transverse colon Mesenteries

Mesentery = double layer of peritoneum created by invagination of peritoneum by an organ

Is the continuity of visceral and parietal peritoneum

Provides a pathway for neurovascular communication between organ and body wall

Contains lymph nodes and variable amounts of fat

The mesentery is the mesentery of the small intestine

The mesocolon is the mesentery of the large intestine

o Transverse mesocolon

o Sigmoid mesocolon Peritoneal ligaments

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page 140 Ligament = double layer of peritoneum connecting an organ to another organ or to the

abdominal wall

Ligaments of the liver:

o Falciform ligament: from liver to anterior abdominal wall

o Gastrohepatic ligament

From lesser curvature of stomach to liver

= a portion of lesser omentum

o Hepatoduodenal ligament

From the liver to the first part of the duodenum

= Right, thickened free edge of lesser omentum

Contains portal triad (portal vein, hepatic artery, bile duct)

Ligaments of the stomach

o Gastrophrenic ligament: from stomach to inferior diaphragmatic surface

o Gastrosplenic ligament: from stomach to hilum of spleen

o Gastrocolic ligament: from stomach as the greater omentum to the transverse colon

Ligaments of the spleen

o Gastrosplenic: from stomach to hilum of spleen

o Splenorenal (lienorenal): from spleen to the left kidney

Phrenicocolic ligament (sustentaculum lienis)

o From the left hepatic flexure of transverse colon to diaphragm

o Supports the spleen Peritoneal subdivisions

Greater sac: main peritoneal cavity

Lesser sac (omental bursa)

o Posterior to the stomach

o Visible through the lesser omentum

o Superior recess: limited by the diaphragm and posterior layers of the coronary ligament of the liver (Section 4-4: Abdomen-Viscera (Gut))

o Inferior recess: potential space between layers of the greater omentum

o Communicates with the greater sac via the epiploic foramen (of Winslow) Boundaries of the epiploic foramen

Boundary StructuresAnterior Hepatoduodenal ligament containing portal triadPosterior Inferior vena cava (IVC) and right crus of diaphragm which is covered by the parietal

peritoneumSuperior Caudate lobe of liver which is covered by the visceral peritoneumInferior First part of duodenum, portal vein, hepatic artery, bile duct

Supracolic compartment

o Greater sac above the transverse mesocolon

o Contains stomach, liver, and spleen

Infracolic compartment

o Greater sac below transverse mesocolon,

o Contains small bowel, ascending and descending colon.

o Divided into left and right divisions by the mesentery of the small intestine

o Free communication between the supracolic and infracolic compartments via the paracolic gutter

Grooves or recesses between the ascending and descending colon and the posterior abdominal wall along their lateral borders

Abdomen: General description

• Lies between the diaphragm and the pelvic inlet.

• Is the largest cavity in the body and is continuous with the pelvic cavity.

• Lined with parietal peritoneum, a serous membrane

• Bounded superiorly by the diaphragm

o Has a concave dome

o Spleen, liver, part of the stomach, and part of the kidneys lies under the dome and are protected by the lower ribs and costal cartilages.

• Lower extent lies in the greater pelvis

o Between the ala or wings of the ilia

o Ileum, cecum, and sigmoid colon thus partly protected

• Anterior and lateral walls composed of muscle

o Viscera in these areas are more likely to be damaged by blunt force and penetrating injuries.

• Posterior wall comprised of vertebral column, the lower ribs, and associated muscles

o Protect the abdominal contents.

Bony landmarks of the abdomen

• Xiphoid process

• Lower six costal cartilages

• Anterior ends of the lower six ribs (ribs 7 to 12) (Section 3-3: Thorax-Body Wall)

• Lumbar vertebrae (L1 to L5)

• Pelvis

o Iliac crest

o Anterior superior iliac spine (ASIS)

o Anterior inferior iliac spine

o Pubic symphysis

o Pubic crest and pubic tubercle

Abdomen: Topographical anatomy

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• Costal margin: Formed by the medial borders of the 7th through 10th costal cartilages

• Rectus sheath

o From xiphoid process and 5th through 7th costal cartilages → pubic symphysis and pubic crest

o Contains rectus abdominis muscle (Section 4-2: Abdomen-Body Wall)

• Linea alba

o A slight indentation that can sometimes be seen extending from the xiphoid process to the pubic symphysis

o A fibrous raphe where the aponeuroses of the external and internal abdominal oblique and the transversus abdominis muscles on either side unite.

• Semilunar line (linea semilunaris)

o Vertical indentation seen as a curved line from the tip of the ninth rib cartilage to the pubic tubercle on each side in well-muscled individuals

o Represents the lateral edge of the rectus abdominus muscle

• Tendinous intersections

o Transverse attachments between the anterior rectus sheath and rectus abdominis muscle

o May be seen as transverse grooves in skin on either side of midline (six-pack)

• Inguinal ligament

o From ASIS to pubic tubercle of pelvis

o Folded inferior edge of external abdominal aponeurosis

o Separates abdominal region from thigh

• Umbilicus

o At approximate level of intervertebral disc between the L3 and L4

o Marks the T10 dermatome

• Liver

o Mainly in the right upper quadrant, behind ribs 7 through 11 on the right side

o Crosses the midline to reach towards the left nipple (Section 4-5: Abdomen-Viscera (Accessory Organs))

• Spleen

o Beneath ribs 9 through 11 on the left side

o 10th rib is axis of spleen

• Kidneys

o Located in loin region

o Left kidney is higher than right (pelvis at L1/2 on left and L2/3 on right) (Section 4-8: Abdomen-Kidneys and Suprarenal Glands)

Abdominal contents

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page 126

• Gastrointestinal tract

o Stomach

o Duodenum

o Ileum

o Jejunum

o Cecum and appendix

o Ascending, transverse and descending colon

o Part of the sigmoid colon

• Accessory digestive organs

o Liver

o Gallbladder

o Pancreas

• Spleen

• Suprarenal glands

• Urinary system-kidneys and ureters

o Kidneys are the only organs developing beneath the parietal peritoneum

o Never have a mesentery

o Thus are primarily retroperitoneal

• Organs that develop within the abdominal cavity and then become retroperitoneal

o Are called secondarily retroperitoneal

o Pancreas

o Two thirds of the duodenum

o Ascending and descending colon.

• All the rest of the organs are peritoneal

o Lie within the peritoneal cavity

o Covered by a layer of visceral peritoneum

o Visceral peritoneum is continuous with the parietal peritoneum lining the cavity via a mesentery.

Abdominal regions

• Abdominal quadrants

o Clinicians usually divide the abdomen is into four quadrants for descriptive purposes, using the following planes:

Median plane: imaginary vertical line following the line alba from the xiphoid process to the pubic symphysis

Transumbilical plane: imaginary horizontal line at the level of the umbilicus

o These lines or planes create four quadrants

Right upper

Left upper

Right lower

Left lower

• Abdominal regions

o Clinicians may divide the abdomen into nine regions

For more accurate descriptive and diagnostic purposes

Use two vertical and three horizontal lines or planes

o Horizontal planes (in descending order):

Subcostal plane: passes through the lower border of the 10th costal cartilage on either side

Sometimes the transpyloric plane is used instead of the subcostal; passes through the pylorus on the right and the tips of the ninth costal cartilage on either side

Transumbilical plane: passes through the umbilicus at the level of the L3/4 intervertebral disc

Transtubercular (intertubercular) plane: passes through the tubercles of the iliac crests and the body of L5

o Vertical planes

Right midclavicular line

Left midclavicular line

Pass from the midpoint of the clavicle to the midpoint of inguinal ligament.

o These planes create nine abdominal regions:

Right and left hypochondriac regions, superiorly on either side

Right and left lumbar (flank) regions, centrally on either side

Right and left inguinal (groin) regions, inferiorly on either side

Epigastric region superiorly and centrally

Umbilical region, with the umbilicus as its center

Hypogastric or suprapubic region, inferiorly and centrally

• Descriptive quadrants and regions are essential in clinical practice

o Each area represents certain visceral structures

o Allow correlation of pain and referred pain from these areas to specific organs.

• Regions and quadrants are palpated, percussed, and auscultated during clinical examination

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page 127

Contents of the Abdominal Quadrants

Right Upper Quadrant (RUQ) Left Upper Quadrant (lUQ)

Liver (right lobe)

Gallbladder

Pylorus (of stomach)

Duodenum (parts 1 through 3)

Pancreas (head)

Right kidney and suprarenal gland

Colon: distal ascending colon, hepatic flexure and right half of transverse colon Liver (left lobe)

Spleen

Stomach

Jejunum and proximal ileum

Pancreas (body and tail)

Left kidney and suprarenal gland

Colon: left half of transverse colon, splenic flexure and superior part of descending colon

Right Lower Quadrant (RLQ) Left Lower Quadrant (LLQ)

Majority of ileum

Cecum with vermiform appendix

Proximal ascending colon

Proximal right ureter Distal descending colon

Sigmoid colon

Left ureter

Ovaries

Uterine tubes

Right and left ductus deferens

Uterus (if enlarged)

Urinary bladder (if full, especially in women)

Peritoneum

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page 139

• Serous membrane

o Lines the abdominopelvic cavity

o Consists of two continuous layers of mesothelium:

o Parietal peritoneum

Lines the internal abdominal wall

Receives its neurovascular supply from the region of the wall it lines

o Visceral peritoneum

Invests abdominal viscera

Receives its neurovascular supply from that of organ

• Peritoneal cavity

o A potential space between the parietal and visceral layers of the peritoneum

o Contains a thin film of fluid

o No organs actually lie within this potential space

o Males: peritoneal cavity is completely closed

o Females: communicates with exterior of body via uterine tubes, uterus, and vagina

• Intraperitoneal organs

o Are organs nearly totally covered by visceral peritoneum

o Not actually inside the peritoneal cavity, but project into the peritoneal cavity

o Are covered by peritoneum

o Are attached to body wall and other organs by mesenteries and ligaments

o Include:

Liver

Spleen

Stomach

First part of duodenum

Jejunum

Ileum

Transverse colon

Sigmoid colon

Superior rectum

• Primarily retroperitoneal organs

o Organs that develop and remain beneath the parietal peritoneum

o Only the kidneys

• Secondarily retroperitoneal organs

o Organs that developed with a short mesentery

o Become pushed against parietal peritoneum lining the body wall by growth of other organs, primarily the small intestine.

o Mesentery of organ fuses with parietal peritoneum: fusion fascia

o Peritoneum covers only its anterior surface, hence, secondarily retroperitoneal

o Organ can be freed at its lateral edge, along the plane of the fusion fascia

o Include

Adrenal glands

Pancreas

Parts two through four of the duodenum

Ascending and descending colon

• Omentum = double-layered fold of peritoneum

• Lesser omentum: connects lesser curve of stomach and proximal duodenum to liver

o Passes from the stomach and first part of the duodenum to adjacent organs

o Consists of two parts:

Hepatogastric ligament

Hepatoduodenal ligament

• Greater omentum

o Hangs down from the greater curve of the stomach and proximal duodenum

o Folds back on itself to attach to the transverse colon

Mesenteries

• Mesentery = double layer of peritoneum created by invagination of peritoneum by an organ

• Is the continuity of visceral and parietal peritoneum

• Provides a pathway for neurovascular communication between organ and body wall

• Contains lymph nodes and variable amounts of fat

• The mesentery is the mesentery of the small intestine

• The mesocolon is the mesentery of the large intestine

o Transverse mesocolon

o Sigmoid mesocolon

Peritoneal ligaments

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page 140

• Ligament = double layer of peritoneum connecting an organ to another organ or to the abdominal wall

• Ligaments of the liver:

o Falciform ligament: from liver to anterior abdominal wall

o Gastrohepatic ligament

From lesser curvature of stomach to liver

= a portion of lesser omentum

o Hepatoduodenal ligament

From the liver to the first part of the duodenum

= Right, thickened free edge of lesser omentum

Contains portal triad (portal vein, hepatic artery, bile duct)

• Ligaments of the stomach

o Gastrophrenic ligament: from stomach to inferior diaphragmatic surface

o Gastrosplenic ligament: from stomach to hilum of spleen

o Gastrocolic ligament: from stomach as the greater omentum to the transverse colon

• Ligaments of the spleen

o Gastrosplenic: from stomach to hilum of spleen

o Splenorenal (lienorenal): from spleen to the left kidney

• Phrenicocolic ligament (sustentaculum lienis)

o From the left hepatic flexure of transverse colon to diaphragm

o Supports the spleen

Peritoneal subdivisions

• Greater sac: main peritoneal cavity

• Lesser sac (omental bursa)

o Posterior to the stomach

o Visible through the lesser omentum

o Superior recess: limited by the diaphragm and posterior layers of the coronary ligament of the liver (Section 4-4: Abdomen-Viscera (Gut))

o Inferior recess: potential space between layers of the greater omentum

o Communicates with the greater sac via the epiploic foramen (of Winslow)

Boundaries of the epiploic foramen

Boundary Structures

Anterior Hepatoduodenal ligament containing portal triad

Posterior Inferior vena cava (IVC) and right crus of diaphragm which is covered by the parietal peritoneum

Superior Caudate lobe of liver which is covered by the visceral peritoneum

Inferior First part of duodenum, portal vein, hepatic artery, bile duct

• Supracolic compartment

o Greater sac above the transverse mesocolon

o Contains stomach, liver, and spleen

• Infracolic compartment

o Greater sac below transverse mesocolon,

o Contains small bowel, ascending and descending colon.

o Divided into left and right divisions by the mesentery of the small intestine

o Free communication between the supracolic and infracolic compartments via the paracolic gutter

Grooves or recesses between the ascending and descending colon and the posterior abdominal wall along their lateral borders

Abdomen: Gambaran umum• terletak antara diafragma dan inlet panggul.• Apakah rongga terbesar dalam tubuh dan kontinu dengan rongga panggul.• Berjajar dengan peritoneum parietal, membran serosa• Bounded superior oleh diafragmao Memiliki kubah cekungLimpa o, hati, bagian perut, dan bagian dari ginjal terletak di bawah kubah dan dilindungi oleh tulang rusuk yang lebih rendah dan kartilago kosta.• sejauh rendah terletak di panggul yang lebih besaro Antara ala atau sayap iliao ileum, sekum, dan kolon sigmoid sehingga sebagian dilindungi• anterior dan lateral dinding terdiri dari ototo jeroan di daerah ini lebih mungkin rusak oleh benda tumpul dan luka tembus.• Posterior dinding terdiri dari tulang punggung, tulang rusuk yang lebih rendah, dan otot yang terkaito Melindungi isi perut.Bony landmark perut• Proses Xifoid• Turunkan enam kartilago kosta• anterior ujung dari enam tulang rusuk yang lebih rendah (rusuk 7 sampai 12) (Bagian 3-3: Thorax-Body Dinding)• Lumbar vertebrae (L1 untuk L5)• Pelviso iliaka cresto anterior spina iliaka superior (ASIS)o anterior tulang rendah iliakao kemaluan simfisiso kemaluan puncak dan kemaluan tuberkulumAbdomen: anatomi topografi

halaman 124

halaman 125• Pesisir margin: Dibentuk oleh perbatasan medial 7 melalui kartilago kosta ke-10• rektus selubungo Dari proses Xifoid dan ke-5 melalui kartilago kosta 7 → simfisis pubis dan puncak kemaluano Berisi otot rektus abdominis (Bagian 4-2: Abdomen-Body Dinding)• Linea albao lekukan sedikit yang kadang-kadang dapat dilihat membentang dari proses Xifoid ke simfisis pubiso raphe berserat mana aponeurosis dari miring perut eksternal dan internal dan otot-otot transversus abdominis di kedua sisi bersatu.• semilunar line (linea semilunaris)o Vertikal lekukan dilihat sebagai garis melengkung dari ujung tulang rawan rusuk kesembilan ke tuberkulum pubikum di setiap sisi dalam berotot individuo Merupakan tepi lateral dari otot rektus abdominus• tendon persimpangano Transverse lampiran antara selubung rektus anterior dan otot rektus abdominiso Dapat dilihat sebagai alur melintang pada kulit di kedua sisi garis tengah (six-pack)• inguinalis ligameno Dari ASIS ke tuberkulum pubikum panggulo Dilipat tepi inferior aponeurosis perut eksternalo Memisahkan daerah perut dari paha• umbilikuso Pada tingkat perkiraan disc intervertebralis antara L3 dan L4o Menandai dermatom T10• Hatio Terutama di kuadran kanan atas, di belakang tulang rusuk 7 hingga 11 di sisi kanano Crosses garis tengah untuk mencapai ke arah puting kiri (Bagian 4-5: Abdomen-jeroan (Organ Aksesori))• Limpao Di bawah rusuk 9 sampai 11 di sisi kirirusuk o 10 adalah sumbu limpa• Ginjalo Terletak di daerah pinggangginjal o kiri lebih tinggi dari kanan (panggul di L1 / 2 di sebelah kiri dan L2 / 3 di kanan) (Bagian 4-8: Abdomen-Ginjal dan Kelenjar suprarenal)Perut Isihalaman 125

Halaman 126

• Saluran cernao Peruto Duodenumo ileumo jejunumo sekum dan usus buntuo Ascending, melintang dan usus menuruno Bagian dari kolon sigmoid• organ pencernaan Aksesorio Hatio Kandung empeduo Pankreas• Limpa• suprarenal kelenjar• urin sistem ginjal dan ureterGinjal adalah organ o hanya mengembangkan di bawah peritoneum parietalo Tidak pernah mesenterium yango Jadi terutama retroperitoneal• Organ yang berkembang di dalam rongga perut dan kemudian menjadi retroperitonealo Apakah disebut sekunder retroperitonealo Pankreaso Dua pertiga dari duodenumo Terkecil dan kolon desendens.• Semua sisa organ yang peritonealo Lie dalam rongga peritonealo Covered oleh lapisan peritoneum visceralo Visceral peritoneum kontinu dengan peritoneum parietal yang melapisi rongga melalui mesenterium a.Perut daerah• abdomen kuadranDokter biasanya membagi o perut adalah menjadi empat kuadran untuk tujuan deskriptif, dengan menggunakan pesawat sebagai berikut: Median pesawat: garis vertikal imajiner mengikuti alba garis dari proses Xifoid ke simfisis pubis Transumbilical pesawat: garis horisontal imajiner pada tingkat umbilikuso Garis-garis atau pesawat membuat empat kuadranKanan atas Kiri atas Kanan rendah Kiri rendah• Perut daerahDokter o dapat membagi perut menjadi sembilan daerah Untuk tujuan deskriptif dan diagnostik yang lebih akurat

Gunakan dua garis horizontal vertikal dan tiga atau pesawato Horizontal pesawat (dalam urutan): pesawat subkostal: melewati batas bawah kartilago kosta ke-10 di kedua sisi Kadang-kadang pesawat transpilorik digunakan bukan subkostal, melewati pilorus di sebelah kanan dan ujung kartilago kosta kesembilan di kedua sisi Transumbilical pesawat: melewati umbilikus pada tingkat disc L3 / 4 intervertebralis Transtubercular (intertuberkularis) pesawat: melewati tuberkel dari puncak-puncak iliaka dan tubuh L5o pesawat Vertikal linea Kanan linea Kiri Lulus dari titik tengah klavikula ke titik tengah ligamen inguinal.o Pesawat ini membuat sembilan daerah perut: hipokondriak daerah kanan dan kiri, superior di kedua sisi kanan dan kiri lumbar (sayap) daerah, terpusat di kedua sisi kanan dan kiri inguinal (selangkangan) daerah, inferior di kedua sisi daerah epigastrik superior dan terpusat umbilical wilayah, dengan umbilikus sebagai pusatnya wilayah hipogastrikus atau suprapubik, inferior dan terpusat• kuadran deskriptif dan daerah sangat penting dalam praktek kliniso Setiap daerah merupakan struktur visceral tertentuo Biarkan korelasi rasa sakit dan nyeri alih dari daerah-daerah pada organ tertentu.• Daerah dan kuadran yang diraba, percussed, dan diauskultasi selama pemeriksaan klinisHalaman 126

halaman 127Isi perut KuadranKuadran kanan atas (kuadran kanan atas) Kiri Atas Quadrant (Luq)Hati (lobus kanan)EmpeduPilorus (perut)Duodenum (bagian 1 sampai 3)Pankreas (kepala)Kanan ginjal dan kelenjar suprarenalColon: distal kolon, ascending hati lentur dan setengah hak Hati kolon melintang (lobus kiri)LimpaPerutJejunum dan ileum proksimalPankreas (badan dan ekor)Kiri ginjal dan kelenjar suprarenalColon: kiri setengah dari melintang, lentur usus limpa dan bagian superior dari kolon desendens

Kuadran kanan bawah (RLQ) Kiri Kuadran Bawah (LLQ)Mayoritas ileumSekum dengan lampiran berbentuk ulatProksimal usus menaikProksimal usus ureter yang tepat turun distalSigmoid kolonKiri ureterOvariumUterine tabungKanan dan kiri duktus deferensUterus (jika diperbesar)Kemih kandung kemih (jika penuh, terutama pada wanita)Selaput peruthalaman 138

Halaman 139• serosa membrano Garis rongga abdominopelvico Terdiri dari dua lapisan terus menerus mesothelium:o parietal peritoneum Garis dinding perut internal yang Menerima pasokan neurovaskular nya dari daerah dinding itu bariso Visceral peritoneum Investasi visera abdomen Menerima pasokan neurovaskular dari bahwa organ• Peritoneal ronggao ruang potensial antara parietal dan lapisan viseral dari peritoneumo Berisi film tipis cairano Tidak ada organ sebenarnya terletak dalam ruang ini potensialo Jantan: rongga peritoneal benar-benar tertutupo Wanita: berkomunikasi dengan eksterior tubuh melalui tabung rahim, rahim, dan vagina• intraperitoneal organo Apakah organ hampir benar-benar tertutup oleh visceral peritoneumo Tidak benar-benar dalam rongga peritoneal, tetapi proyek ke dalam rongga peritonealo Apakah ditutupi oleh peritoneumo Apakah melekat pada dinding tubuh dan organ lainnya oleh polip dan ligameno Termasuk: Hati Limpa Perut Pertama bagian dari duodenum

jejunum ileum Transverse usus sigmoid kolon Unggul rektum• Terutama retroperitoneal organo Organ yang berkembang dan tetap di bawah peritoneum parietalo Hanya ginjal• Sekunder retroperitoneal organo Organ yang berkembang dengan mesenterium singkato Menjadi mendorong terhadap peritoneum parietal yang melapisi dinding tubuh oleh pertumbuhan organ lain, terutama usus kecil.o Mesenterium sekering organ dengan peritoneum parietal: fasia fusiono Peritoneum hanya mencakup permukaan anterior nya, maka, sekunder retroperitonealo Organ dapat dibebaskan di tepi lateral, sepanjang bidang fasia fusio Sertakan adrenal kelenjar Pankreas Bagian dua sampai empat dari duodenum Terkecil dan kolon desendens• omentum = berlapis ganda kali lipat dari peritoneum• Lesser omentum: menghubungkan kurva yang lebih rendah dari lambung dan duodenum proksimal ke hatio Passes dari bagian perut dan pertama dari duodenum ke organ yang berdekatano Terdiri dari dua bagian: Hepatogastric ligament Hepatoduodenal ligamen• Greater omentumo Hang turun dari kurva yang lebih besar dari perut dan duodenum proksimalo melipat kembali pada dirinya sendiri untuk melampirkan ke kolon transversumPolip• Mesenterium lapisan ganda peritoneum = diciptakan oleh invaginasi peritoneum oleh organ• Apakah kelangsungan peritoneum viseral dan parietal• Menyediakan jalur untuk komunikasi neurovaskular antara organ dan dinding tubuh• Berisi kelenjar getah bening dan jumlah variabel lemak• mesenterium adalah mesenterium usus kecil• mesokolon adalah mesenterium usus besaro Transverse Mesokolono Sigmoid mesokolonPeritoneal ligamenHalaman 139

halaman 140• Ligamentum lapisan = peritoneum ganda yang menghubungkan organ ke organ lain atau ke dinding perut• Ligamen dari hati:o bengkok ligamen: dari hati ke dinding anterior abdomeno Gastrohepatic ligamen Dari kurvatura minor lambung ke hati = sebagian kecil omentumo Hepatoduodenal ligamen Dari hati ke bagian pertama dari duodenum = kanan tepi, bebas penebalan lebih rendah omentum Mengandung Portal triad (vena portal, arteri hepatika, saluran empedu)• Ligamen dari peruto Gastrophrenic ligamen: dari perut ke permukaan diafragma rendaho gastrolienale ligamen: dari perut ke hilus lieno Gastrocolic ligamen: dari perut sebagai omentum yang lebih besar pada kolon transversal• Ligamen limpao gastrolienale: dari perut ke hilus lieno Splenorenal (lienorenale): dari limpa ke ginjal kiri• Phrenicocolic ligamentum (sustentaculum lienis)o Dari lentur hati kiri kolon melintang diafragmao Mendukung limpaPeritoneal subdivisi• Greater sac: rongga peritoneal utama• Lesser kantung (omentum bursa)o Posterior ke peruto Terlihat melalui omentum minuso Unggul istirahat: dibatasi oleh diafragma dan lapisan posterior ligamentum koroner hati (Bagian 4-4: Abdomen-jeroan (Gut))o Inferior istirahat: ruang potensial antara lapisan omentum yang lebih besaro Berkomunikasi dengan kantung besar melalui foramen epiploika (dari Winslow)Batas foramen epiploikaBatas StrukturAnterior Hepatoduodenal ligamen mengandung Portal triadPosterior inferior vena cava (IVC) dan kanan crus dari diafragma yang ditutupi oleh peritoneum parietalBerekor superior lobus hati yang ditutupi oleh peritoneum viseralInferior Pertama bagian dari duodenum, vena portal, arteri hepatika, saluran empedu

• Supracolic kompartemeno lebih besar kantung atas mesokolon transversumo Berisi lambung, hati, dan limpa

• Infracolic kompartemeno lebih besar kantung bawah melintang Mesokolon,o Berisi usus kecil, usus besar naik dan turun.o Terbagi dalam divisi kiri dan kanan oleh mesenterium usus kecilo Gratis komunikasi antara kompartemen supracolic dan infracolic melalui selokan paracolic Grooves atau relung antara usus turun naik dan dinding perut posterior sepanjang perbatasan lateral mereka