Clinical Anatomy of GIT and Urinary Tract [Autosaved]

7/22/2019 Clinical Anatomy of GIT and Urinary Tract [Autosaved]

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Embriology

Foregut : Pharynxprimordial (cavum oris,lingua, glandulasalivarius), respiratorysystem, esofagus sampai

papilla duodeni mayor,hepar, pankreas

Midgut: Duodenumsisanya sampai 2/3proksimal colon

transversum Hindgut: sisanya

ditambah epitel vesicaurinaria dan uretra


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Conted

Cavitas peritonii:Coeloem intraembryonic Peritoneum parietal: mesoderm somatic

Peritoneum visceral: mesoderm splachnic

Mesenterium: double layer peritoneum

Mesogastrium dorsal omentum majus, lig.Gastrolienalis, lig. Gastrophrenica, lig. Gastrocolica

Mesogastrium ventral lig. Falciformis, lighepatoduodenal, lig hepatogastrica


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Esophagus

VC6-VT11 Pars cervical, thoracal, abdominal

Inner circular, outer longitudinal

Penyempitan (angustia) superior, media, inferior

Klinis Fistula tracheoesophageal

GERD, kelemahansphincter lower. Ygmana sphincterlower? Achalasia Varises esofageal(portocaval shunt)


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Gaster Fundus, cardia, corpus,

pars pylorus, pylorus

Incissura cardiaca &incissura angularis

Tunica mucosa: rugae

gastrica, canalisgastricus

Tunica muscularis: outerlongitudinal, middlecircular, inner oblique

Tunica serosa:peritoneum visceral

Vaskularisasi a. gastrica dexter & sinisteranastomosis di curvatura minor a. gastroepiploica dex & sinanastom di curvatura mayor a. gastrica brevis & posteriorsuplai fundus v. gastrica dex et sin v. Portahepatica v. gastroepiploica sin & brevis v.Lienalis v. gastroepiploica dex v.Mesenterica sup

InervasiParasimpatis: trunkus vagusant & postSimpatis: T6-T9 n. splachnicus

mayor


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Cont ed

Klinisnyaa.. Hiatal hernia

Hernia diafragma congenital (bochdalek)

Hypertrophic pyloric stenosis

Ca gaster, sering di pylorus Gastroscope (nasally/orally)

Gastrectomy (total dan parsial)

Gastritis dan gastric ulcer

Vagotomy

truncal: jarang!

selective: Cuma dipilih yg menuju ke segmen

gaster tertentu

Slidinghernia

Paraesophageal

hernia


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Duodenum Pars superior (ada ampullanya lho), pars descenden, pars

horizontal, pars ascenden

Yang mana yg intraperitoneal dan retro?

Lig. hepatoduodenal

Flexura duodeni superior (L1) et inferior (L3)

Flexura duodenojejunales (L2) ligamentum suspensoriumduodenojejunales (Treitz)

Papilla duodeni mayor dan acessorius

Plica circularisVaskularisasi

A. GastroduodenalA. Pancreaticoduodenalsup infVenanya ke v. PortahepatisInervasi

n. Vagus dan n.S lachnicus ma or et


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Lanjoot..

Klinisnya apaan dong?

Duodenal ulcer: bisa erosi ke a. gastroduodenal

Peptic ulcer: karna asam lambung berlebih

Hernia paraduodenal: di sekitar flexuraduodenojejunales melalui fossa duodeni sup etinf, fossa paraduodenal, plica paraduodenal


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Conted

Nah klinisnya.. Diverticulum ilei

(Meckel):gagalnyapenutupan ductomphalomecentericus

74% free 26% nempelke umbilicus

Mucosa: ileal type,gastric type,pancreatic, jejunale,atw colonic

Iskemia small intestine: occlusivasa recta oleh emboli nekrosis

ileusIleus: nyeri colic, distensi,vomiting, fever dan dehidrasi

Ileostomy: stoma dari ileum kekulit dinding anterolateral

Megacolon (Hirschprung)


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Large Intestine Caecum, appendix, colon

ascenden, transversum,descenden, sigmoid,rectum, dan canalis analis

Haustra & incissurasemilunaris

Appendices epiploica Taenia coli (libera,

mesocolica, omentalis)

Plica semilunaris

Mesocolon transversum

Mesocolon sigmoid

Flexura hepatica &lienalis

Junctio rectosigmoid

Posisi appendix?Retrocaecal, preileal,

retroileal, pelvica, dll


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Klinisnyaa Appendicitis, McBurney

di garis Monroe

Colectomy (removal)

Colitis

Colostomy, pembuatan

stoma di pars terminalcolon

IBD

Diverticulosis,diverticulitis

Volvulus, hanya untukyg intra


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Rectum & Anus

Retroperitoneal dansubperitoneal

Canalis analis

Linea pectinata

(dentata), batasembriologis

Junctio anocutan

M. Levator ani

M. Sphincter ani internus

(involunter) M. Sphincter ani externus

(volunter)


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Klinisss

Atresia ani

Stenosis ani

Hemorrhoid

Internal: plexus

venosus rectalisinternal

Eksterna: plexusvenosus rectalisexterna, sakit

Batesnya si lineadentata


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Hepar

Intraperitoneal Fascies

diaphragmatica &visceralis

Recessussubphrenicus &

hepatorenal Area nuda, sulcus

vena cava inferior Fossa vesica fellea,

porta hepatis (apa aja?)

Impressio Lobus anatomis,

fisiologis Segmen?

Blood flowTruncus coeliacus - a. Hepaticacommunis a. Hepatica propria portahepatis - ramus dex et sinv. Mes sup + v. Lienalis = v. Portahepatica

v. Mes inf ke v. lienalisVena2 abdomen v. Porta he atica


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Portocaval shunt

Letak Porta Cava

Esofagus v. gastrica sinistra v. esofageales

Paraumbilical v. paraumbilicalis v. Epigastricasuperficialis

Anus v. Rectalis sup v. Rectalis med&inf Retroperitoneal v. Colica sinistra v. Lumbalis ascenden

Klinisnya..

sirosis hepatis hepatomegaly hepatitis


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Organ aksesoris lainnya

Lien: splenomegaly(inget schuffnernya),splenectomy

Vesica fellea:cholecystitis,

cholelithiasis (termasukcholedocolithiasis,cholecystolithiasis)bikin nyeri colic biliarryReferred Painnyakemana?Gaster : T6-T9 ke epigastric

Cholelithiasis, hepar, ductuscysticus: T6, bisa sampescapula dorsal dexter


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Summary Inervasi danVaskularisasForegut badan sel preganglionik di nucleus intermediolateralis (IML) T6-9 serabut preganglionik : T6-9 (N. Splachnici mayor) badan sel postganglionik : Ganglion coeliacum

Midgut bdn sel preganglionik : IML T10-12 serabut preganglionik : T10-12 (n. Splachnici minor)Bdn sel postganglionik : Ganglion mesentericus superior

Hindgut IML L1-3 L1-3 (N. Splachinici lumbales) G. Mesentericus sup


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URINARY & ABDOMINAL

WALLLanjut dikit lagii, smangat!


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Abdominal Wall

9 Regio

M. Obliqus externus(V)

M. Obliqus internus (A)

M. TransversusSubcostal (costa10)

2 versi garis transversa:

transpyloric &interspinosasubcostal &transtubercular


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Clinical oriented? Incisi abdomen Peritonitis Adhesi peritoneum:

perlekatan viscera, bsajadi volvulus

Adhesiotomy Ascites: excavatio douglas

(cewe), excavatiorectovesica, recessushepatorenal (supine)

Abdominal paracentesis :untuk ambil cairan, admantibiotik. Melalui dinding

abdomen anterolateral(linea alba) Intraperitoneal dialysis:

seperti menyaring cairan(darah). Peritoneumsebagai membransemipermeabel.

Digunakan temporer Injeksi intraperitoneal


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Hernia Abdominales

Locus minoris resistante

Fossa inguinalis media(trigonum Hasselbach)

Fossa inguinalis lateral

Trigonum lumbales

Annulus femoralis

Annulus umbilicales

Maka jenis hernianya..

Hernia direct

Hernia indirect

Hernia lumbales Hernia femorales

Hernia umbilicalis

Hernia epigastrica


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Urinary System

Embriologi

Pronephros

Mesonephros: glomeruli dan tubulus mesonephros,ductus mesonephricus

Metanephros: primordia ren permanen

Ren permanen berkembang dari 2 sumber:

Diverticulum metanephric (ureteric bud): ureter, pelvisrenalis, sistema collectivus

Metanephrogenic blastema: parenkim (nephron)

Ren migrasi week 9


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Kelainan congenital

Bifid renal pelvis andureter: complete incomplete

Horseshoe kidney :tertahan di bawah a.

Mesenterica inf (L3-L5) Ectopic pelvic kidney:

ren di pelvis

Retrocaval ureter

Polycystic kidney:

autosomal dominan


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Anatomy normalnya?

T12-L3

Retroperitoneal

Lemak pararenal,fascia renalis

(Gerotta), lemakperirenal, capsularenalis (capsulafibrosa)

Fiksasi ren : fascia2

dan lemaknya,tekanan intraabdm,vasa renalis danureter

Collecting system :

Papilla renalis, calixminor, calix mayor,


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Conted

Ureter (pars abdominalis & parspelvica)

Vesica urinari: ingat detrusor + reflexmiksi?


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Langsung klinisnya aja ya..

Nephroptosis: turun lebihdari 3cm

Glomerulonephritis,Pyelonephritis

Hydronephrosis +Hydroureter, obstrusi

Ureterolithiasis, predileksiada 3

Vesicolithiasis


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Suprapubiccystostomy

Cystoscopy(transurethra)

Incontinensia

True: fistula, extrofibladder

Stress: kelemahandiafragma pelvis

Urge: hiperrefleks m.Detrusor, spasticUMN, flaccid LMN

Overflow: udh penuhga bisa kontraksi, atw


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ESWL

Cystoscopy

Bladder extrofi


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ALHAMDULILLAH

Clinical Anatomy of GIT and Urinary Tract [Autosaved]

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