PMDC NEB Step-1 Day-6 (Review of Abdomen)

GIT

ModuleAbdominal Wall

Prof. Saeed Shafi

5

Quadrants of Abdomen

7

GIT

8

GIT

9

Trunk

1. Liver

2. Asc. colon

3. Sigmoid colon

4. Heart

5. Trans colon

6. Desc. colon

7. Small Bowel

SUPERFICIAL

NERVE

DISTRIBUTION

PARACENTESIS OF ABDOMINAL CAVITY

HERNIA OF

ANTEROLATERAL

ABDOMINAL

WALL

Cutaneous veins do not follow

arteries

VENOUS AND

LYMPHATIC DRAINAGE

OF ANTERIOR

ABDOMINAL WALL

Abdominal incisions

Median

Paramedian

Transverse

Subcostal- Kocher’s

Supra pubic- Pfannenstiel

Morrison’s

Grid Iron- McBurney

Find and identify palpable landmarks that

clinicians use to locate internal structures

Use landmarks to locate

only those structures

examined during the

physical exam

Surface anatomy to introduce the physical exam

Ccommon surgical incisionsUse the incisions to compare andcontrast different regions of the abdominal wall

© 2010 Lawrence Rizzolo, Ph.D., Yale University

Use surface anatomy to perform common surgical procedures

30

Vertical disposition of peritoneum

31

Vertical disposition of peritoneum

ATTACHMENT OF MESENTERIES

Vertical disposition of peritoneum

EXTRA-EMBRYONIC COELOM

2nd week1st week

INTRA-EMBRYONIC COELOM

3rd week

INTRA-EMBRYONIC COELOM

Pericardial cavity

Pleural cavity

Peritoneal cavity

IEC

EEC

PERICARDIAL CAVITY

INTRA-EMBRYONIC COELOM

HeartPeritoneal

cavity

Pericardial

cavity

Pericardioperitoneal

canal

PERITONEAL CAVITY

PERICARDIO-PERITONEAL CANALS

Pericardio-

peritoneal

canal

Pericardial cavity

PERITONEAL CAVITY

(Liver)

PERITONEAL CAVITY

(Umbilicus)

PERITONEAL CAVITY

(Hindgut)

PLEURO-PERITONIAL MEMBRANES

Pleural cavityBronchial Buds

TOS# Themes %

1 Dysphagia 5

2 Dyspepsia 10

3 Jaundice 10

4 Acute Pancreatitis 10

5 Acute Abdomen 25

6 Diarrhea 10

7 Lower GIT bleed 10

8 Inguino-scrotal swellings 5

9 Nutrition 15

Grand Total 100%

The Gastro-intestinal Tract

• Hollow muscular tube that transports food &

liquid to the stomach

• Extends from pharynx to stomach

• Follows curve of vertebral column

• Pierces diaphragm at level of T10 vertebra

• Covered anteriorly & laterally in abdomen by

peritoneum= retroperitoneal

• Arterial supply

inferior phrenic artery

left gastric artery

• Venous drainage

left gastric vein

OESOPHAGUS

PARTS OF STOMACH

Angular notch : along lesser curvature; junction of body & pyloric part

Cardia : around opening of oesophagus

Fundus : dilated superior part - related to left dome of diaphragm

Body : between fundus & pyloric antrum

Pyloric part : has 2 parts - pyloric antrum & pyloric canal

Intestinal mucosa bears :

• transverse folds =

plicae circulares

• small projections =

intestinal villi

• both increase surface

area for absorption

• each villus contains a

terminal lymphatic

called a lacteal

PARTS OF SMALL INTESTINEExtends from pylorus to ileocaecal junction

Includes duodenum, jejenum, ileum

Small intestine plays primary role in digestion & absorption of nutrients

FIRST PART OF SMALL INTESTINE : DUODENUM

• Shortest, widest, most fixed part

• Has C-shaped course around head of pancreas

• Begins at pylorus; ends at duodenojejunal

junction

ARTERIAL SUPPLY

• Superior pancreaticoduodenal artery

(coeliac trunk)

• Inferior pancreaticoduodenal artery

(superior mesenteric artery)

VENOUS DRAINAGE

• Follow arteries - drain into portal vein

• Bile & pancreatic ducts enter its posteromedial

wall

• Duodenojejunal flexure : Junction of duodenum

& jejunum

• Begins as a pouch inferior to terminal portion of ileum

• Ends at anus

Functions :

1. Reabsorb water, compact feces

2. Absorb vitamins liberated

by bacteria

3. Store fecal material before

defecation

LARGE INTESTINE : FUNCTIONS

3 components viz.

1. CECUM

• Collects, stores chyme

• Ileocecal valve opens into it

2. COLON

• Bears haustra, taeniae coli, epiploic

appendages

• Subdivided into 4 regions

ascending

transverse

descending

sigmoid

• Terminates in anorectal canal

PARTS OF LARGE INTESTINE

3. RECTUM

• Leads to anus

• Muscular sphincters control passage of

fecal material to anus

PARTS OF LARGE INTESTINE: CAECUM

• First part of large intestine

• Continuous with ascending

colon

• Lies in iliac fossa

• Does not have a mesentery

• Has vermiform appendix

attached inferior to ileocaecal

junction

• Appendix has short triangular

mesentery = mesoappendix- that

suspends it from mesentery of

terminal ileum

PARTS OF LARGE INTESTINE: ASCENDING COLON

• Passes superiorly from caecum on

right side of abdominal cavity to

liver, turns to left as right colic

flexure

• Lies retroperitoneally along side

posterior abdominal wall

• Covered with peritoneum anteriorly

& on its sides

• Separated from anterior abdominal

wall by coils of small intestine &

greater omentum

PARTS OF LARGE INTESTINE: TRANSVERSE COLON

• Largest, most mobile part

• Crosses abdomen from right

colic flexure to left colic

flexure - bends inferiorly to

become descending colon

PARTS OF LARGE INTESTINE: DESCENDING COLON

Passes retoperitoneally from left

colic flexure into left iliac fossa,

becomes continuous with sigmoid

colon

PARTS OF LARGE INTESTINE: SIGMOID COLON

S-shaped loop - variable in length, links descending colon & rectum.

Extends from pelvic brim to 3rd segment of sacrum where it joins rectum

ACCESSORY DIGESTIVE ORGANS

• Liver

• Gallbladder

• Pancreas

• Hollow muscular

organ

• Stores & concentrates

bile

• Has fundus, body,

neck

GALLBLADDER

• Has head, body, tail

• Pancreatic duct

penetrates wall of

duodenum

• Pancreas is an

exocrine & endocrine

organ

PANCREAS

Exocrine functions:

* Secreting H2O

* Secretes ions

* Digestive enzymes into small intestine

Portal circulation

Sites of portosystemic anastomosis