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Home , Angular incisure, Left gastroepiploic vein

بسم هللا الرحمن الرحيم

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Abdomen Part 4

2 and Abdominal Vicsera

3 Greater Omentum and Abdominal Vicsera, Greater Omentum Raised

4 Mesenteric Relations of Intestines Elevated

5 Mesenteric Relations of Intestines Removed

6 The Root of Mesentery

• The short root of small intestinal mesentery is continuous with parietal peritoneum on posterior abdominal wall along a line that extends downward to right from left side of 2nd lumbar vertebra to region of right sacroiliac joint • It permits exit and entrance of arterial, venous and lymphatic vessels, and to intestine

7 Function of Peritoneum

• 1- Movements (gliding) of viscera on each other • 2- Peritoneal fluid contains leukocytes secreted from peritoneum • 3- Peritoneal fluid is not static and moves continuously toward subphrenic space quickly absorbed into lymphatic capillaries of diaphragmatic peritoneum • 4- Vessels and supply to viscera • 5- Fat storage (large amount) • 6-Providing extensive surface for absorption and secretion (peritoneal dialysis)

8 Mesenteric Relations of Intestines Reflected

9 Mesenteric Relations of Intestines Reflected

10 Suspensory Muscle of (Ligament of Treitz, Dirived from Right Diphragmatic Crus)

11 12 13 14 15 16 17 18 19 Relations of Epiploic foramen

• Anterior: free border of lesser omentum & its components • Posterior: IVC • Superior: Caudate process of liver • Inferior: 1st part of duodenum

20 21 Question 1

• How do you define peritoneal pouches?

22 Mesenteric Relations of Intestines Sigmoid Colon Reflected

23 Question 2

• What is the function of peritoneal membrane?

24 25 Stomach Variation in position and contour

26 Stomach Variation in position and contour • Hypertonic • Position & body • Orthotonic shape of stomach • Hypotonic depend: • Atonic • Habitus (Body build) • Its fullness • Its muscle tone • Status of surrounding viscera

27 Surface Anatomy of stomach

• Upper and left part of : • Epigastric area • Umblical area • Left hypochondriac area

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29 Cardia &

• Cardia lies: Behind 7th C.C. 2.5 cm left of midline at the level of T11 • Pylorus lies 2.5 cm right of midline at the level of L1 • Between these two points the stomach is fixed and position & body shape of stomach depends to: ……

30 Stomach Parts

• Cardiac orifice • Cardiac incisure • Fundus • Body • Angular incisure • Pyloric antrum • Pyloric canal • Pyloric orifice

31 32 33 34 35 36 37 38 39 40 Gastric Cells

+ Fundus and Body: • 1- Chief or peptic cells, digestive enzymes • 2- Parietal or oxyntic cells, Acid and intrinsic factor • 3- Mucus cells, mucus • 4- Neuroendocrine cells, somatostatin & histamine • 5- Somastotine is secreted by D cells which inhibits gastrin • 6- Histamine role is like gastrin + Pylorus: Gastrin, is released by G cells under influence of mechanical stimuli and increases gastric motility and secretions of chief & oxyntic cells + Cardia: Mucus and lyzozym is secreted from cell in this region

41 Relations Anterior surface:

• Left ribs & costal margin • Left lobe of liver • Left dome of diaphragm separates stomach from left lung and heart • Anterior abdominal wall

42 43 Relations Posterior surface: Inside lesser sac: • Pancreas • Spleen • Splenic vessels • Left kidney • Left Suprarenal gland • Transverse mesocolon

44 Blood Supply

• 1- Left gastric • 2- Right gastric artery • 3- Right gastroepiploic artery • 4- Left gastroepiploic artery • 5- Short gastric

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46 Venous Drainage

• 1- Left gastric & • 2- Right gastric vein Portal vein • 3- Left gastroepiploic vein & 4- Short gastric Splenic vein 5- Right gastroepiploic vein Superior mesentric vein

47 Venous Drainage

48 Lymphatic drainage of stomach • Area I = Superior 1/3 • Area II = Inferior 1/3 • Area III = Left superior 1/3

49 50 Lymphatic drainage of stomach • Area I: along left and right gastric artery to aortic nodes • Area II: along right gastroepiploic artery to subpyloric nodes • Area III: along short gastric and splenic artery to suprapancreatic nodes

51 52 Lymphatic Drainage of stomach • All lymph reach celiac nodes • In rare case of stomach carcinoma there might be a supracalvicular lymphadenopathy (Virschow ganglion)

53 Innervation

• 1- Sympathetic fibers from celiac plexus (T6 –T10) • 2- Sympathetic fiber are vasomotor and motor to pyloric sphincter, but inhibitory for rest of stomach • 3- Sympathetic fibers contains also pain fibers • 4- Parasympathetic fibers from L & R vagal trunks: • Anterior, gives rise branches to stomach and a branch to liver a branch of which goes to pyloric region • Posterior, gives rise to branches to stomach and a branch to celiac ganglion • Parasympathetic fibers are motor and secretomotor to stomach but inhitbitory to pyloric sphincter

54 Anterior & posterior vagal trunks

55 Myenteric & Sub mucosal Plexus

56 57 58

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62 63 Applied Anatomy

• Gastric pain is felt in epigastrium and T6 - T10 are its responsible dermatoms • Pain is produced by spasm or by overdistention

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66 Duodenum

• Duodenum means twelve • Ancient anatomists suggested: 12 finger breadth, about 25 cm • Including 4 parts: • 1st part, superior, cap, or bulb, 5cm • 2nd or descending part, 8 cm • 3rd or horizontal part, 8cm • 4th or short ascending part, 5cm

67 68 69 Duodenum, continued

• Duodenal Cap: • Its medial half: • Superiorly: • free edge of lesser omentum is attached • Inferiorly: • greater omentum and transverse mesocolon is attached • So, this part is a bit mobile

70 Duodenum, continued

• Duodenal Cap: • Anteriorly : • Liver & gall bladder overlap this part • Posteriorly : • Gastroduodenal artery, portal vein and bile duct cross it vertically (partially embedded in the head of pancreas)

71 72 Duodenum, continued

• 2nd part: • Descends along right side of verte. L1,2,3 • Anterior: • Liver, transverse mesocolon, transverse colon and coils of • Posterior: hilum of right kidney, right ureter • Lateral: , right colic flexture right lobe of liver • Medial: common bile duct embedded in the head of pancreas, joins with main pancreatic duct

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