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Mvdr. Natália Hvizdošová, Phd. Mudr. Zuzana Kováčová

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Mvdr. Natália Hvizdošová, Phd. Mudr. Zuzana Kováčová MVDr. Natália Hvizdošová, PhD. MUDr. Zuzana Kováčová ABDOMEN Borders outer: xiphoid process, costal arch, Th12 iliac crest, anterior superior iliac spine (ASIS), inguinal lig., mons pubis internal: diaphragm (on the right side extends to the 4th intercostal space, on the left side extends to the 5th intercostal space) plane through terminal line Abdominal regions superior - epigastrium (regions: epigastric, hypochondriac left and right) middle - mesogastrium (regions: umbilical, lateral left and right) inferior - hypogastrium (regions: pubic, inguinal left and right) ABDOMINAL WALL Orientation lines xiphisternal line – Th8 subcostal line – L3 bispinal line (transtubercular) – L5 Clinically important lines transpyloric line – L1 (pylorus, duodenal bulb, fundus of gallbladder, superior mesenteric a., cisterna chyli, hilum of kidney, lower border of spinal cord) transumbilical line – L4 Bones Lumbar vertebrae (5): body vertebral arch – lamina of arch, pedicle of arch, superior and inferior vertebral notch – intervertebral foramen vertebral foramen spinous process superior articular process – mammillary process inferior articular process costal process – accessory process Sacrum base of sacrum – promontory, superior articular process lateral part – wing, auricular surface, sacral tuberosity pelvic surface – transverse lines (ridges), anterior sacral foramina dorsal surface – median, intermediate, lateral sacral crest, posterior sacral foramina, sacral horn, sacral canal, sacral hiatus apex of the sacrum Coccyx coccygeal horn Layers of the abdominal wall 1. SKIN 2. SUBCUTANEOUS TISSUE + SUPERFICIAL FASCIAS + SUPRAFASCIAL STRUCTURES Superficial fascias: Camper´s fascia (fatty layer) – downward becomes dartos m. Scarpa´s fascia (membranous layer) – downward becomes superficial perineal fascia of Colles´) dartos m. + Colles´ fascia = tunica dartos Suprafascial structures: Arteries and veins: cutaneous brr. of posterior intercostal a. and v., and musculophrenic a. and v. superficial epigastric a. and v. superficial circumflex iliac a. and v. thoracoepigastric v. – abdominal subcutaneous v. – paraumbilical vv. Lymph: axillary and inguinal nll. Nerves: lateral and anterior cutaneous branches of intercostal nn. (Th7-Th11) subcostal n. (Th12) iliohypogastric n. (L1 – lumbar plexus) ilioinguinal (L1 – lumbar plexus): enters scrotum through superficial inguinal ring 3. DEEP FASCIA – FASCIA OF EXTERNAL OBLIQUE ABDOMINIS M. gets on: scrotum as an external spermatic fascia thigh as a fascia lata 4. MUSCLES OF THE ABDOMINAL WALL ventral group: rectus abdominis m. – tendinous intersections, rectus sheath (anterior layer, posterior layer) – arcuate line (Douglas), linea alba pyramidalis m. anterolateral group: external oblique abdominal m. – inguinal lig. (lacunar lig. – pectineal lig., reflex lig.) – superficial inguinal ring: medial and lateral crus, intercrural fibers internal oblique abdominal m. transversus abdominis m. – semilunar line – deep inguinal ring: interfoveolar lig., inguinal falx (conjoint tendon) dorsal group: quadratus lumborum m. psoas major and minor m. 5. TRANSVERSALIS FASCIA 6. PARIETAL PERITONEUM - internal surface of anterior abdominal wall - five peritoneal folds which extend toward the umbilicus: median umbilical fold – obliterated urachus supravesical fossa medial umbilical fold (paired) – obliterated umbilical a. medial inguinal fossa – superficial inguinal ring lateral umbilical fold (paired) – inferior epigastric vessels lateral inguinal fossa – deep inguinal ring Arteries of the abdominal wall posterior intercostal aa. – lateral cutaneous brr. superior epigastric a. (origin: internal thoracic a.) – anterior cutaneous brr. inferior epigastric a. – anterior cutaneous brr. superficial epigastric a. deep circumflex iliac a. superficial circumflex iliac a. Veins of the abdominal wall thoracoepigastric v. abdominal subcutaneous vv. posterior intercostal vv. – lateral cutaneous brr. superficial epigastric v. superficial circumflex iliac v. deep circumflex iliac v. superior epigastric v. – anterior cutaneous brr. inferior epigastric v. – anterior cutaneous brr. Nerves of the abdominal wall intercostal nn. (Th7-Th11) – lateral cutaneous brr., anterior cutaneous brr., muscular brr. subcostal n. (Th11) iliohypogastric n. (L1) – lumbar plexus ilioinguinal n. (L1) – lumbar plexus INGUINAL CANAL entrance: deep inguinal ring (lateral inguinal fossa) – medial and lateral crus, intercrural fibers exit: superficial inguinal ring (medial inguinal fossa) – interfoveolar lig., inguinal falx (conjoint tendon) Walls of the inguinal canal: anterior: aponeurosis of external oblique abdominal m. superior: fibers of internal oblique abdominal m. and transversus abdominal m. inferior: inguinal lig. posterior: transversalis fascia (interfoveolar lig., inguinal falx) Content: ♂ spermatic cord, cremasteric a., ilioinguinal n., genital br. of genitofemoral n. ♀ round ligament of the uterus, artery of round lig., ilioinguinal n., genital br. of genitofemoral n. DIGESTIVE SYSTEM Oral cavity Vestibul of mouth upper lip – nasolabial sulcus, philtrum, tubercle of upper lip, frenulum of upper lip superior fornix of vestibule lower lip – mentolabial sulcus, frenulum of lower lip inferior fornix of vestibule rima oris (oral fissure), commissure of lips (angle of mouth), parotid papilla (opening of parotid duct at the level of 2nd upper molar) Proper oral cavity gingiva (gum) gingival margin interdental papilla gingival sulcus Teeth superior and inferior dental arches tooth (dens, odontos) – dental crown (enamel), dental neck (cement), dental root (cement, apex radicis dentis), pulp cavity, dental pulp . incisors . canines . premolars . molars Tongue root of tongue – lingual tonsil, median and lateral glossoepiglottic folds, epiglottic valleculae body of tongue – median sulcus, terminal sulcus, foramen cecum, vallate papillae, fungiform papillae, filiform papillae, lingual aponeurosis, lingual septum apex of tongue margin of tongue – foliate papillae inferior surface of tongue – fimbriated fold, frenulum of tongue, sublingual caruncula, sublingual fold Muscles of tongue: . extrinsic – genioglossus m., hyoglossus m., palatoglossus m., styloglossus m. intrinsic – superior and inferior longitudinal mm., transverse muscle of tongue, horizontal muscle of tongue Palate hard palate – transverse palatine folds (rugae palatinae), palatine raphe, incisive papilla, palatine glands solf palate – uvula, tensor veli palatini m., levator veli palatini m., palatoglossus m., palatopharyngeus m., uvulae m. Salivary glands minor salivary gll. – labial gll., buccal gll., lingual gll. (anterior lingual gl.), palatine gll., molar gll. major salivary gll. parotid gl. (parotid duct on parotid papilla) . sublingual gl. (minor sublingual duct, major sublingual duct on sublingual caruncula) . submandibular gl. (submandibular duct on sublingual caruncula) Oropharyngeal isthmus (fauces) . uvula . palatoglossal arch – triangular fold . palatopharyngeal arch . semilunar fold . tonsilar fossa – palatine tonsil . supratonsillar fossa Pharynx nasal part (nasopharynx) – external base of skull to C2 oral part (oropharynx) – C2-C4 laryngeal part (laryngopharynx) – C4-C6, aditus laryngis (laryngeal inlet), piriform recess, plica nervi laryngei (laryngeal fold) Pharyngeal muscle Constrictors superior pharyngeal constrictor m. – pterygopharyngeal part, buccopharyngeal part, mylopharyngeal part, glossopharyngeal part middle pharyngeal constrictor – chondropharyngeal part, ceratopharyngeal part inferior pharyngeal constrictor – thyropharyngeal part, cricopharyngeal part pharyngeal raphe Levatores stylopharyngeus m. salpingopharyngeus m. palatopharyngeus m. retropharyngeal space, parapharyngeal space Esophagus cervical part – C6-Th2 thoracic part – Th2-Th10 abdominal part – Th10-Th11 pharyngooesophageal, bronchoaortic, diaphragmatic constriction Blood supply and innervation: Arteries: inferior thyroid a. (thyrocervical trunk), posterior intercostal aa., esophageal brr. (thoracic aorta), left gastric a. Veins: esophageal vv., inferior thyroid v., azygos v., hemoazygos v. ( SVC), gastric vv. ( portal v.) Lymph: deep cervical nll., tracheobronchial nll., posterior mediastinal nll., left gastric lnn. Nerves: parasympathetic – vagus n., sympathetic – sympathetic trunk Stomach (ventriculus, gaster) anterior wall – hepatic, diaphragmatic, free surfaces posterior wall – splenic, renal, suprarenal, pancreatic, colic, mesocolic surfaces cardiac part (cardia) – cardiac orifice, cardiac notch fundus of stomach – fornix of stomach body of stomach – gastric canal, gastric folds, greater curvature, lesser curvature – angular notch pyloric part – pyloric antrum, pyloric canal, pyloric orifice – sphincter pylori m. Blood supply and innervation: Arteries: right and left gastric a., right and left gastroepiploic a., short gastric aa. Veins: right and left gastric v., right and left gastroepiploic v., short gastric vv. Lymph: right and left gastric lnn., right and left gastroepiploic lnn., coeliac lnn., splenic lnn., intestinal trunk Nerves: parasympathetic – vagus n. (anterior and posterior vagal trunk), sympathetic – sympathetic trunk (greater and lesser splanchnic n.) Small intestine – circular folds, mesentery Duodenum . superior part (L1) – ampulla (bulb) of duodenum, superior duodenal flexure, intraperitoneally . descending part (L1-L3) – longitudinal fold of duodenum, major duodenal papilla (Vater`s)
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