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2.7 Duodenum and pancreas 2.8 Kidneys, suprarenal glands and ureters 2.9 Posterior abdominal wall and diaphragm Abdomen 4 Albert van Schoor GNK 288 (SA4.

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Presentation on theme: "2.7 Duodenum and pancreas 2.8 Kidneys, suprarenal glands and ureters 2.9 Posterior abdominal wall and diaphragm Abdomen 4 Albert van Schoor GNK 288 (SA4."— Presentation transcript:

1 2.7 Duodenum and pancreas 2.8 Kidneys, suprarenal glands and ureters 2.9 Posterior abdominal wall and diaphragm Abdomen 4 Albert van Schoor GNK 288 (SA4 Anatomy dissection)

2 2.7 Duodenum and pancreas Surface anatomy Structure Blood supply, nerve supply and lymph drainage

3 2.7.1 Surface anatomy Review the surface anatomy of the duodenum and pancreas Name the vertebral heights of the various parts of the pancreas

4 1 st part Approx. 5 cm long Anterolateral of body of L1 On the transpyloric line Surface Anatomy

5 2 nd part Approx cm long Descends along the right sides of L1-L Surface Anatomy

6 3 rd part Approx. 6-8 cm long Horisontal Crosses the body of L Surface Anatomy

7 4 th part Approx. 5cm cm long Begins at the left of L3 Rises superior as far as the superior border of L Surface Anatomy

8 T12 L2 L1 L2 L Surface Anatomy

9 2.7.2 Structure Identify and briefly describe the four parts of the duodenum and the structures opening into it

10 1 st part 1 st 5cm from gastroduodenal junction Anterior: –Liver –Gallbladder Posterior: –Ant. Border of omental foramen (gastroduodenal artery) Structure

11 2 nd part 7-10cm long Vertical Curves around head of pancreas Anterior: –Transverse colon Posterior: –Right kidney and ureter Posteromedial: –Major and minor duodenal papillae Structure

12 3rd part Horisontal 6-8cm Anterior: –Superior mesenteric artery –Mesentry of small intestines Posterior: –IVC –Aorta –L3 Superior: –Head of pancreas Structure

13 4th part Runs vertical for cm to duodenojejenal junction Suspensory ligament of duodenum (Lig. of Treitz) extend from right crus of diaphragm Suspends duedenojejenal junction Structure

14 Identify and schematically illustrate the different parts (regions) and duct system of the pancreas Identify and list the general and peritoneal relations of the four parts of the duodenum Identify and briefly discuss the relations of the pancreas to the spleen, duodenum, stomach and transverse colon and peritoneum Identify the root of the transverse colon

15 Major pancreatic duct of Wirsung Accessory pancreatic duct of Santorini Structure

16 Identify and briefly discuss the relations of the pancreas to the spleen, duodenum, stomach and transverse colon and peritoneum Identify the root of the transverse colon

17 Superior: –Splenic artery –Common hepatic artery Posterior: –IVC –Aorta –Sup. mesenteric vessels –Crurae of diaphragm –Coeliac plexus –Left kidney Anterior: –Stomach –Transverse mesocolon –Omental bursa Structure

18 2.7.3 Blood supply and lymph drainage Identify, trace and list the arterial supply and venous drainage of the duodenum and pancreas Give a broad overview of the major lymph node groups into which the upper abdominal organs drain

19 2.7.3 Blood & Lymph

20 Veins follows the arteries Drains into portal vein either directly or indirectly through: –Superior mesenteric vein –Splenic vein Blood & Lymph

21 2.8 Kidneys, suprarenal glands and ureters Surface anatomy Structure Blood supply, nerve supply and lymph drainage Radiographic anatomy

22 2.8.1 Surface anatomy Review the surface anatomy of the kidneys Identify the bony relations of the kidneys and ureters

23 Left: –5cm from median plane –Transpyloric line through hilum of kidney Right –Transpyloric line through superior pole of kidney –Inferior pole 2.5cm from ileac crest L1 L Surface Anatomy

24 T12 T11 Psoas Major Quadratus Lumborum Transverse Abdominis Surface Anatomy

25 2.8.2 Structure Annotate a coronal section of the kidneys as follows: hilus, pelvis, calices, pyramids and columns Identify and name the general and peritoneal relationships of both kidneys Identify and name the abdominal course and relationships of both ureters in both sexes

26 2.8.2 Structure Identify both suprarenal glands Compare the relative position of the two kidneys and suprarenal glands Distinguish the three parts of the ureter and list where a kidney stone might obstruct it

27 2.8.2 Structure

28 Approximately 25cm long Urine moves by means of peristaltic movements 3 Components: –Abdominal: adjacent to transverse processes of lumbar vertebrae L2-L5 –Pelvic: enters true pelvis, continues medial, over internal iliac artery, and anteromedial towards bladder –Intramural: short part between 2 layers of bladder wall. Serves as a mechanical valve to prevent reflux of urine Structure

29 Potential constrictions: –Renal pelvis –Where ureter crosses the internal iliac artery –Between the 2 muscle layers of the bladder wall Structure

30 2.8.3 Blood supply, nerve supply and lymph drainage Trace, identify and compare the course and relations of both renal arteries and veins Identify, trace and name the arterial supply and venous drainage of both suprarenal glands

31 2.8.3 Blood & nerve supply, Lymph drainage

32 2.8.4 Radiographic anatomy Identify the following on a urogram (or IVP): –Kidneys –ureters, –bladder, –major and minor calyces, –pelvis of kidney, and –relation of the ureters to the transverse processes of the lumbar vertebrae

33 2.9 Posterior abdominal wall and diaphragm Abdominal aorta Abdominal inferior vena cava Lymph drainage Nerve structures Fascia Muscles Diaphragm Osteology

34 2.9.1 Abdominal aorta Identify the course, relationships and branches of the abdominal aorta

35 3 unpaired to viscera (anterior) –Coeliac trunk –Sup. mesenteric –Inf. mesenteric 3 paired to viscera (lateral) –Suprarenal –Renal –Gonadal 5 paired (lateral) –Inferior phrenic –4 pairs of lumbar 2 paired terminal branches –Common iliac –Median sacral Abdominal aorta

36 2.9.2 Abdominal inferior vena cava Briefly discuss and identify the course, relations and tributaries of the inferior vena cava Identify the different drainage of the left and right gonadal veins

37 2.9.3 Lymph drainage Give a broad overview of the lymph drainage of the abdomen

38 2.9.4 Nerve structures Identify and briefly describe the sympathetic trunk and where possible the plexuses

39 2 parallel nerve cords Extending on either side of the vertebral column from the base of the skull to the coccyx. 2 sympathetic trunks come together anterior to the coccyx to form the ganglion impar Nerve structures

40 Identify and discuss the distribution and root values of the following nerves of the lumbar plexus: –Subcostal, –iliohypogastric, –ilioinguinal, –lateral cutaneous nerve of the thigh, –genitofemoral, –femoral and –obturator nerves Give an overview of the autonomic nerve supply of the abdomen

41 Splanchnic nerves –Thoracic (Coeliac plexus) –Lumbar (Intermesenteric / aortic & superior hypogastric plexus) –Sacral (Inferior hypogastric plexus) –Pelvic * (Inferior hypogastric plexus) * Both sympathetic and parasympathetic Autonomic SympatheticParaympathetic Vagus nerve (X) ~ cranial outflow –Foregut & midgut S2-S4 ~ abdominal outflow –Hindgut Intermesenteric / aortic plexus Superior & inferior mesenteric plexuses Superior & inferior hypogastric plexuses Nerve structures

42 2.9.5 Fascia Identify the layers of the thoracolumbar fascia Identify the psoas and iliac fascia

43 2.9.6 Muscles Identify and briefly discuss the major attachments, relationships to organs and nerves, as well as the nerve supply of the following muscles: –psoas major, –iliacus and –quadratus lumborum

44 MuscleOriginInsertionInnervation Psoas major Lateral surface of bodies and intervertebral discs of T12 and L1 to L5, transverse processes of the lumbar vertebrae Lesser trochanter of the femur Anterior rami of L1 to L3 Quadratus Lumborum Transverse process of L5, iliolumbar ligament, and iliac crest Transverse processes of L1-L4 and inferior border of rib 12 Anterior rami of T12 and L1 to L4 Iliacus Upper two-thirds of iliac fossa, anterior sacro-iliac and iliolumbar ligaments, and upper lateral surface of sacrum Lesser trochanter of femur Femoral nerve (L2 - L4) Muscles

45 2.9.7 Diaphragm Review the surface anatomy of the diaphragm Identify and name it's attachments, blood supply and nerve supply

46 1a) Vertebral ~ crura Right Crus –L1-L3 Left Crus –L1-L Diaphragm

47 1b) Vertebral ~ fibrous arches Median arcuate lig –aorta Medial arcuate lig –Psoas major Lateral arcuate lig –Quadratus lumborum Diaphragm

48 2) Costal Ribs ) Sternal 2 small attachments to xiphisternum Diaphragm

49 Innervation –Motor supply ~ phrenic nerve Blood supply ~ superior –Superior phrenic artery (thoracic aorta) –Musculophrenic and pericardiophrenic arteries(internal thoracic artery) Blood supply ~ inferior –Inferior phrenic artery (abdominal aorta) Diaphragm

50 List it's superior and inferior relations on the left and right Identify and name the orifices of the diaphragm with their vertebral heights and contents and the structures penetrating the diaphragm separately

51 T8 T10 T Diaphragm

52 Identify and name the arcuate ligaments of the diaphragm and the structures related posterior to them Identify and name the crura of the diaphragm in relation to the oesophageal hiatus

53 2.9.8 Osteology Identify and briefly discuss the bony elements of the posterior abdominal wall


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