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Organs located intraperitoneally. Abdomen, peritoneum and peritoneal cavity

Starting from the stomach, sections digestive tract together with the large glands (liver and pancreas), as well as the spleen and organs of the genitourinary apparatus, are located in the abdominal cavity and pelvic cavity.

Abdomen

Abdomen, cavitas abdominis , (Greek lapara - womb, hence laparotomy - the operation of opening the abdomen) - this is the space located in the body below the diaphragm and filled with abdominal organs. The abdominal cavity contains the stomach, small and large intestines (except for the rectum), liver, pancreas, spleen, kidneys, adrenal glands, and ureters. In addition, on the posterior wall of the abdominal cavity, in front of the lumbar vertebral bodies, the abdominal aorta and the inferior vena cava pass and lie nerve plexuses, lymphatic vessels and nodes. The pelvic cavity contains the rectum, organs of the urinary system and internal genital organs.

The inner surface of the abdominal cavity is lined with intra-abdominal fascia, fascia endoabdominalis , or retroperitoneal fascia, fascia subperitonealis . The parietal peritoneum is adjacent to the inner surface of this fascia.

The entire abdominal cavity can be seen only by removing the peritoneum and internal organs.

Topography:

The upper wall of the abdominal cavity is the diaphragm.

The anterior wall is formed by aponeuroses (tendon stretches) of the three lateral muscles and the rectus abdominis muscles.

The lateral walls include the muscular parts of the lateral abdominal muscles.

The posterior wall is formed by the lumbar part of the spinal column, the psoas major muscle and the quadratus lumborum muscle.

Below, the abdominal cavity passes into the pelvic cavity, the bottom of which is the muscles and fascia of the perineum.

To determine the projection of organs onto the anterior abdominal wall, it is divided by two horizontal lines into three floors:

I. epigastrium (epigastrium) – from the diaphragm to linea bicostarum , drawn between the ends of the X edges;

II. mesogastrium (womb) – between linea bicostarum And linea bicristarum , drawn between the anterior superior iliac spines;

III. hipogastrium (hypogastrium) – below linea bicristarum to the pelvic diaphragm.

Each of the three floors is divided by two vertical lines drawn along the lateral edges of the rectus abdominis muscles into three more secondary areas:

I. epigastrium :

1. regio epigastrica (epigastrium);

2. regio hypochondrica dextra (right hypochondrium);

3. regio hypochondrica sinistra (left hypochondrium);

II. mesogastrium :

1. regio umbilicalis (umbilical region);

2. regio abdominalis lateralis dextra (right lateral abdominal area);

3. regio abdominalis lateralis sinistra (left lateral abdominal area);

III. hipogastrium :

1. regio pubica (pubic area);

2. regio inquinalis dextra (right groin area);

3. regio inquinalis sinistra (left groin area).

The abdominal cavity is divided into the peritoneal cavity (peritoneal cavity), cavitas peritonei , and retroperitoneal space, spatium retroperitoneale . The peritoneal cavity is lined with a serous membrane called the peritoneum, peritoneum .

Peritoneum

Peritoneum, peritoneum , is a serous membrane lining the abdominal cavity and covering the internal organs located in this cavity. It is formed by the lamina serosa itself and single-layer squamous epithelium - mesothelium. The peritoneum consists of two layers: parietal, parietal, peritoneum parietale , and visceral, peritoneum viscerale . The parietal peritoneum lines the anterior and lateral walls of the abdomen with a continuous layer from the inside and then continues to the diaphragm and the posterior abdominal wall. Between the peritoneum and the walls of the abdomen there is a connective tissue layer with a greater or lesser content of fatty tissue. It is absent in the area of the diaphragm, but on the posterior wall of the abdominal cavity it is well defined, covering the kidneys, ureters, adrenal glands, abdominal aorta and inferior vena cava with their branches. The visceral peritoneum covers the internal organs, forming their serous cover over a greater or lesser extent. Both leaves are in close contact with each other. When the abdominal cavity is not opened, there is a narrow gap between them, called the peritoneal cavity, cavitas peritonei , which contains a small amount of serous fluid that moisturizes the surface of the organs and facilitates their movement relative to each other.

Limiting the closed peritoneal cavity (peritoneal cavity), cavitas peritonei (peritonealis) , the peritoneum is a continuous layer that passes from the walls of the abdominal cavity to the organs and from the organs to its walls. The peritoneal cavity is a closed serous sac, which only in women communicates with the external environment through the abdominal openings of the fallopian tubes.

Topography of the peritoneum:

Ø The peritoneum on the inner surface of the lower part of the anterior abdominal wall forms five folds converging towards the navel, umbilicus :

1) unpaired median umbilical, plica umbilicalis mediana (covers the overgrown urinary duct, urachus );

2) paired medial umbilicals, plicae umbilicales mediales (covers overgrown umbilical arteries);

3) paired lateral umbilicals, plicae umbilicales laterales (covers the inferior epigastric arteries).

The listed folds are delimited on each side above bladder and the inguinal ligament with three fossae:

Between the median and medial umbilical folds lie the supravesical fossa, fossae supravesicales .

Between the medial and lateral umbilical folds are the medial inguinal fossae, fossae inquinales mediales , corresponding to the position of the deep ring of the inguinal canal.

Lateral to the lateral umbilical folds are the lateral inguinal fossae, fossae inquinales laterales , corresponding to the position of the outer ring of the inguinal canal.

Under medial part inguinal ligament present fossa femoralis , which corresponds to the position of the inner ring of the femoral canal.

Ø Up from the navel, the peritoneum passes from the anterior abdominal wall and diaphragm to the diaphragmatic surface of the liver in the form of a falciform ligament, lig.falciforme hepatis , between the two leaves of which in its free anterior edge lies the round ligament of the liver, lig.teres hepatis (overgrown umbilical vein).

Ø The peritoneum behind the falciform ligament from the lower surface of the diaphragm wraps onto the diaphragmatic surface of the liver, forming the coronary ligament, lig.coronarium hepatis , in the free edges of which there are triangular extensions forming triangular ligaments, lig. triangulare dextrum et lig. triangulare sinistrum .

Ø From the diaphragmatic surface of the liver, the peritoneum moves through the lower edge of the liver to the visceral surface, from which it passes from the right lobe to the upper end of the right kidney, forming lig.hepatorenale .

Ø From the portal of the liver, the peritoneum goes to the lesser curvature of the stomach and the upper part of the duodenum in the form lig.hepatogastricum et lig.hepatoduodenale . Both of these ligaments are duplications of the peritoneum and, being a continuation of one into the other, together they form the lesser omentum, omentum minus . In the thickness of the hepatoduodenal ligament pass (from right to left) the common bile duct ( ductus choledochus ), portal vein ( vena portae ) and the proper hepatic artery ( arteria hepatica propria ). If you take the first letters of the Latin names of the structures of the lesser omentum, you get the word “DVA”

Ø On the lesser curvature of the stomach, both layers of the lesser omentum diverge: one layer covers the anterior surface of the stomach, the other covers the posterior surface. On the greater curvature of the stomach, both layers converge again and descend down in front of the transverse colon, forming lig.gastrocolicum , and then further ahead of the loops small intestine, forming the anterior plate of the free part of the greater omentum, omentum majus . Having gone down, both leaves turn back up, forming the back plate of the free part of the greater omentum. Thus, the large oil seal has two parts: fixed, lig.gastrocolicum , and free, consisting of 4 layers of peritoneum. The posterior plate of the greater omentum, consisting of two layers of peritoneum, reaches the transverse colon and fuses with it and its mesentery. Together with the latter, it goes back to the anterior edge of the pancreas. From here the leaves diverge: one, covering the anterior surface of the pancreas, goes up to the diaphragm, and the other, covering the lower surface of the gland, passes into the mesentery of the transverse colon.

Ø Let us now trace the course of the peritoneum from the same leaf, but not in the upward direction to the diaphragm, but in the transverse direction. From the anterior abdominal wall, the peritoneum lines the side walls of the abdomen and, moving to the posterior wall, on the right surrounds the cecum on all sides with a vermiform appendix, which receives the mesentery - mesoappendix . The peritoneum covers the ascending colon from the sides and in front, the lower part of the anterior surface of the right kidney, the ureter and at the root of the mesentery of the small intestine radix mesenterii bends into the right leaf of this mesentery. It envelops the jejunum and ileum on all sides and passes into the left layer of the mesentery of the small intestine - mesenterium . The peritoneum further covers the left kidney in front and approaches the descending colon, covering it from the front and sides, and on the side wall of the abdomen again wraps onto the anterior abdominal wall.

Ø Descending into the pelvic cavity, the peritoneum covers its walls and the organs lying in it. In order to more easily assimilate complex relationships, the entire peritoneal cavity can be divided into 3 floors:

The upper floor is bounded above by the diaphragm, below by the transverse colon and its mesentery, mesocolon transversum ;

The middle floor extends from mesocolon transversum down to the entrance to the pelvis;

The lower floor starts from the line of entry into the small pelvis and corresponds to the pelvic cavity.

Ø In the upper floor of the peritoneal cavity there are three bags: bursa hepatica, bursa pregastrica, bursa omentalis .

hepatic bursa, bursa hepatica , covers the right lobe of the liver and is separated from the pregastric bursa by lig.falciforme hepatis ; behind it is limited to the right side lig.coronarium hepatis et lig. triangular dextrum . In the depths of the bursa, under the liver, the upper pole of the right kidney with the adrenal gland is palpated.

pregastric bursa, bursa pregastrica , covers the left lobe of the liver, the anterior surface of the stomach, the spleen; The left part of the coronary ligament and the left triangular ligament run along the posterior edge of the left lobe of the liver. The spleen is covered on all sides by peritoneum (intraperitoneal), which in the hilum area passes to the stomach, forming lig.gastrolienale , and to the diaphragm - lig.phrenicolienale .

Omental bag, bursa omentalis , is the cavity of the peritoneum lying behind the stomach and lesser omentum. The omental bag has 4 walls:

upper – caudate lobe of the liver,

lower - mesentery of the transverse colon,

anterior - lesser omentum, posterior wall of the stomach, lig.gastrocolicum ,

Posterior – peritoneum covering the pancreas.

The cavity of the omental bursa communicates with the general cavity of the peritoneum through the omental opening - foramen epiploicum . It is limited:

from above – the caudate lobe of the liver,

front – lig.hepatoduodenale ,

· behind - lig.hepatorenale ,

· left – lig.gastrolienale And lig.phrenicolienale .

Ø The middle floor of the peritoneal cavity becomes visible if the greater omentum and transverse colon are lifted upward. Between the lateral walls of the abdomen and colon ascendens And colon descendens the right and left lateral channels are located, canales laterales dexter et sinister .

Ø The space covered by the colon is divided by the mesentery of the small intestine, running from top to bottom and from left to right, into two mesenteric sinuses, sinus mesentericus dexter et sinister . Mesentery of the small intestine, mesenterium , consists of two layers, between which pass the branches of the superior mesenteric arteries and veins, lymphatic vessels and nodes. The posterior edge of the mesentery, attached to the wall of the abdomen and forms the root of the mesentery, radix mesenterii . The line of attachment of the mesenteric root goes obliquely: from the left side of L II to the right iliac fossa.

Ø On the posterior parietal layer of the peritoneum there are a number of peritoneal pits, which are of practical importance, because they can serve as a site for the formation of retroperitoneal hernias:

At the junction of the duodenum and the jejunum, depressions are formed - recessus duodenalis superior et recessus duodenalis inferior .

In the area of the transition of the ileum to the cecum there are two fossae - recessus ileocaecalis superior et recessus ileocaecalis inferior . Behind the cecum, during the transition of the visceral peritoneum to the parietal peritoneum, a recessus retrocaecalis .

On the left side there is recessus intersigmoideum , this fossa is noticeable on the lower (left) surface of the mesentery of the sigmoid colon, if it is pulled upward.

Ø The lower floor is represented by the peritoneum, covering the walls of the small pelvis and the organs of the genitourinary apparatus, therefore the relationships of the peritoneum here depend on gender. The pelvic section of the sigmoid colon and the upper third of the rectum are covered with peritoneum on all sides (intraperitoneal). The middle section of the rectum is covered with peritoneum from the anterior and lateral surfaces (mesoperitoneal), while the lower section is not covered with it (extraperitoneal). In men, the peritoneum, passing from the anterior surface of the rectum to the posterior surface of the bladder, forms a depression, excavatio rectovesicalis . In women, the course of the peritoneum in the pelvis is different, due to the fact that the uterus is located between the bladder and rectum. Therefore, in the pelvic cavity in women there are two peritoneal spaces: excavatio rectouterina And excavatio vesicouterina - between the uterus and bladder. Excavatio rectouterina called the pouch of Douglas in the clinic.

Ø The organs are covered by the peritoneum in different ways:

Intraperitoneal - from all sides, many organs have a mesentery. These include the abdominal esophagus, stomach, upper part duodenum, spleen, jejunum and ileum (mesentery - mesenterium ), cecum and appendix ( mesoappendix ), transverse colon ( mesocolon transversum ), sigmoid colon ( mesosigmoideum ), fallopian tube ( mesosalpinx ). The ovary is not covered by the mesentery, but has a mesentery - mesovarium .

Mesoperitoneal - on two or three sides. Mesoperitoneally covered: liver, gallbladder, ascending and descending colon, middle third of the rectum, filled bladder, uterus (since the vaginal part of the uterus is not covered by peritoneum).

Extraperitoneal - on one side. These organs are located behind the peritoneum (retroperitoneal). Extraperitoneally covered: duodenum, pancreas, kidneys, left adrenal gland (the right adrenal gland is not covered by the peritoneum, because it is adjacent to the right lobe of the liver), the lower third of the rectum, an unfilled bladder.

The organs of the digestive system following the esophagus are located in the abdominal cavity (abdominal cavity), and the final section - the rectum - is in the pelvic cavity.

Abdominal cavity (abdominal cavity) is the largest cavity in the human body and is located between the thoracic cavity and the pelvic cavity. The cavity is limited from above by the diaphragm, from behind by the lumbar spine, the quadratus lumborum muscles, the iliopsoas muscles, and from the front and sides by the abdominal muscles. Below, the abdominal cavity continues into the pelvic cavity, which is limited below by the pelvic diaphragm.

The abdominal cavity contains the stomach, small and large intestines (excluding the rectum), liver, pancreas, spleen, kidneys, adrenal glands, ureters, and the pelvic cavity contains the rectum, organs of the urinary system and internal genital organs. In addition, on the posterior wall of the abdominal cavity, in front of the lumbar vertebral bodies, there are the abdominal aorta, the inferior vena cava and nerve plexuses, lymphatic vessels and nodes.

The inner surface of the abdominal cavity is exposed intra-abdominal fascia or retroperitoneal fascia, the areas of which are named depending on the name of the muscles it covers. The parietal peritoneum is adjacent to the inner surface of this fascia (see below).

The entire abdominal cavity can be seen only by removing the peritoneum and internal organs. Between the peritoneum and intraperitoneal fascia there is fatty tissue. There is especially a lot of it on the back wall near the internal organs located there. The space between the fascia and peritoneum on the posterior abdominal wall is called retroperitoneal space. It is filled with fatty tissue and organs.

Peritoneum, peritoneum, is a serous membrane lining the abdominal cavity and covering the internal organs located in this cavity. It is formed by the lamina serosa itself and single-layer squamous epithelium - mesothelium. The peritoneum, which lines the walls of the abdominal cavity, is called parietal peritoneum; the peritoneum that covers the organs is called visceral peritoneum. The total surface of the parietal and visceral peritoneum in an adult occupies an average area of 1.71 m2. Limiting the closed peritoneal cavity, the peritoneum is a continuous layer that passes from the walls of the abdominal cavity to the organs and from the organs to its walls. In women, the peritoneal cavity communicates with the external environment through the abdominal openings of the fallopian tubes, the uterine cavity and vagina. The peritoneal cavity contains a small amount of serous fluid that moisturizes the peritoneum, which ensures free movement of the adjacent organs covered by the peritoneum.

The relationship of the peritoneum to the internal organs is different. Some organs are covered with peritoneum on only one side (pancreas, most of the duodenum, kidneys, adrenal glands, etc.), i.e., they lie outside the peritoneum, retroperitoneally (retro- or extraperitoneal). Each such organ is called retroperitoneal organ. Other organs are covered by peritoneum on only three sides and are mesoperitoneally lying organs (ascending and descending colon). The organs that make up the third group are covered with peritoneum on all sides and occupy an intraperitoneal (intraperitoneal) position (stomach, small intestine, transverse and sigmoid colon, spleen, liver).

The peritoneum, which passes from the walls of the abdominal cavity to organs or from organ to organ, in some cases forms folds and pits. When moving to some intraperitoneal organs, the peritoneum forms ligaments and doubling (duplication) of the peritoneum - mesentery. For example, mesenterium - mesentery of the small intestine (from the Greek mesos - middle, enteron - intestine), mesocolon - mesentery of the colon.

Fig.31. Section of the body in the transverse plane. Relation of internal organs to the peritoneum (diagram):

1- visceral peritoneum; 2- parietal peritoneum; 3- mesentery of the small intestine; 4- intraperitoneal position of the small intestine; 5- mesoperitoneal position of the ascending colon; 6- retro (extra)peritoneal position of the kidney; 7- abdominal cavity

The parietal peritoneum, lining the walls of the abdominal cavity, unlike the visceral peritoneum, does not form mesenteries. Covering the anterior abdominal wall, the parietal peritoneum passes at the top to the diaphragm, at the sides to the lateral walls of the abdominal cavity, and at the bottom to the organs of the pelvic cavity. In the pubic region, between the peritoneum and the retroperitoneal fascia, there is a small amount of adipose tissue, due to which the peritoneum here is pushed upward by the bladder when it is filled (Fig. 31).

Throughout the entire length between the navel and the pubic symphysis, the peritoneum covering the anterior abdominal wall forms 5 folds: unpaired median umbilical fold, doubles medial and lateral umbilical folds. In the median umbilical fold there is an overgrown urinary duct (urachus), which runs in the fetus from the top of the bladder to the navel; in the medial umbilical folds there are overgrown umbilical arteries, through which blood from the fetus is directed to the placenta, and in the lateral folds there are inferior epigastric arteries.

Above the bladder on the sides of the median umbilical fold there are small depressions - right and left supravesical fossae. Between the lateral and medial umbilical folds on each side there is medial inguinal fossa. The superficial inguinal rings of the right and left inguinal canals are projected into them. Outward from the lateral umbilical fold is located lateral inguinal fossa, corresponding to the deep inguinal ring of the inguinal canal.

Heading upward, the peritoneum of the anterior wall of the abdominal cavity passes to the lower surface of the diaphragm, and then from the diaphragm to the internal organs (liver, stomach, spleen) and to the posterior abdominal wall.

The peritoneum of the anterior abdominal wall also passes to the lateral walls of the abdominal cavity, and then to the posterior wall. On the posterior wall of the abdominal cavity, the peritoneum covers the retroperitoneal (retroperitoneal) organs (kidneys, adrenal glands, ureters, pancreas, most of the duodenum, aorta, inferior vena cava, etc., vessels and nerves, lymph nodes) and passes to other organs, lying meso- and intraperitoneally. On three sides (mesoperitoneally), the peritoneum covers the ascending and descending parts of the colon, and on all sides covers the cecum, which lies intraperitoneally, but does not have a mesentery.

The vermiform appendix, also located intraperitoneally, has mesentery of the appendix. In the left part of the abdominal cavity, two layers of peritoneum approach the sigmoid colon, cover it on all sides and form mesentery of the sigmoid colon. On the border of the upper and lower sections of the abdominal cavity in the transverse direction there is mesentery of the transverse colon, represented by two layers of peritoneum extending from the posterior wall of the abdominal cavity to the transverse colon. Below the mesentery of the transverse colon, it originates from the posterior abdominal wall mesentery of the small intestine into which the parietal peritoneum passes. Root of the mesentery of the small intestine, located obliquely, from top to bottom and from left to right, from the duodenum-jejunal flexure (to the left of the body of the II lumbar vertebra) to the transition of the ileum to the cecum (the level of the right sacroiliac joint). Its length is 15-17 cm. The edge of the mesentery opposite to the root, which approaches the small intestine and then envelops it on all sides (intraperitoneal position of the intestine), is equal to the total length of the jejunum and ileum. Between the two serous layers of the mesentery there pass the superior mesenteric artery with branches and nerves heading to the small intestine, as well as veins and lymphatic vessels emerging from the walls of the intestine. The superior mesenteric lymph nodes, loose connective and adipose tissue are also located there.

Much more difficult is the transition of the parietal peritoneum to the visceral peritoneum and the formation of mesenteries in the upper floor of the peritoneal cavity (above the transverse colon and its mesentery) (Fig.). From the lower surface of the diaphragm, the peritoneum passes to the diaphragmatic surface of the liver, forming the liver ligaments: sickle-shaped, coronal, right and left triangular ligaments. Wrapping around the sharp edge of the liver in front and the back of the liver, the peritoneum covers the visceral surface of the organ. Then, from the gate of the liver, the peritoneum is directed in two sheets to the lesser curvature of the stomach and the upper part of the duodenum. Thus, between the portal of the liver at the top, the lesser curvature of the stomach and the upper part of the duodenum at the bottom, a duplication of the peritoneum is formed, called lesser omentum. The left side of the lesser omentum represents hepatogastric ligament, and the right one - hepatoduodenal ligament. In the right edge of the lesser omentum (in the transverse duodenal ligament) between the layers of the peritoneum there are located, from right to left, the common bile duct, the portal vein and the proper hepatic artery.

Approaching the lesser curvature of the stomach, the two layers of peritoneum of the hepatogastric ligament diverge and cover the posterior and anterior surfaces of the stomach. At the greater curvature of the stomach, these two layers of peritoneum converge and go down in front of the transverse colon and in front of the small intestine. Then these sheets of peritoneum together bend sharply posteriorly, tuck in and rise upward behind the descending sheets

Fig.32. Section of the body in the median (sagittal) plane. Relation of internal organs to the peritoneum (diagram).

1 - liver; 2 – hepatogastric ligament; 3 – omental bag; 4 – pancreas; 5 – duodenum; 6 – mesentery of the small intestine; 7 – rectum; 8 – bladder; 9 – jejunum; 10 – transverse colon; 11- cavity of the greater omentum; 12 – mesentery of the transverse colon; 13 - stomach.

and anterior to the transverse colon. Above the mesentery of the transverse colon, the layers pass into the parietal peritoneum, covering the posterior abdominal wall. The upper layer goes up, covering the upper surface of the pancreas, and then passes to the posterior wall of the abdominal cavity and to the diaphragm. The lower leaf turns down and passes into the upper (anterior) leaf of the mesentery of the transverse colon. The long fold of peritoneum hanging in front of the transverse colon and loops of the small intestine in the form of an apron and formed by four layers of peritoneum is called greater omentum, which in origin is the posterior (dorsal) mesentery of the stomach. Between the layers of the peritoneum of the greater omentum there is a small amount of fatty tissue. The four layers of the peritoneum of the greater omentum in an adult fuse two at a time into two plates - anterior and posterior. The anterior plate begins from the greater curvature of the stomach and, together with the posterior plate of the greater omentum, in turn fuses with the anterior surface of the transverse colon at the level of the omental band. The posterior plate of the greater omentum also fuses with the mesentery of the transverse colon.

The part of the greater omentum (anterior plate), stretched between the greater curvature of the stomach and the transverse colon, is called gastrocolic ligament. Two layers of peritoneum extending from the greater curvature of the stomach to the left to the hilum of the spleen form gastrosplenic ligament, going from the cardiac part of the stomach to the diaphragm - gastrophrenic ligament.

The peritoneal cavity can be divided into three floors, or sections: upper, middle and lower. Top floor bounded above by the diaphragm, on the sides by the lateral walls of the abdominal cavity, covered with the parietal peritoneum, and below by the transverse colon and its mesentery.

The upper floor contains the stomach, liver with gall bladder, spleen, upper part of the duodenum and pancreas. The upper floor of the peritoneal cavity is divided into three relatively delimited sacs, or bursae: hepatic, pregastric and omental. Hepatic bursa located to the right of the falciform ligament of the liver and covers the right lobe of the liver. The retroperitoneal upper pole of the right kidney and the adrenal gland protrude into the hepatic bursa. Pregastric bursa located in frontal plane, to the left of the falciform ligament of the liver and anterior to the stomach. In front, the pregastric bursa is limited by the anterior abdominal wall. The upper wall of this bag is formed by the diaphragm. In the pregastric bursa are left lobe liver and spleen.

Omental bag located behind the stomach and lesser omentum. It is bounded above by the caudate lobe of the liver, below by the posterior plate of the greater omentum, fused with the mesentery of the transverse colon, in front by the posterior surface of the stomach, lesser omentum and gastrocolic ligament, and behind by the sheet of peritoneum covering the aorta, lower vena cava, upper pole of the left kidney, left adrenal gland and pancreas. The cavity of the omental bursa is a slit located in the frontal plane. The outlines of the cavity of the omental bursa are uneven. At the top she has upper gland recess, which is located between the lumbar part of the diaphragm behind and the posterior surface of the caudate lobe of the liver in front. To the left, the omental bursa extends all the way to the hilum of the spleen, forming splenic recess. The walls of this recess are ligaments: in front - the gastrosplenic, in the back - the diaphragmatic-splenic, which is a duplication of the peritoneum running from the diaphragm to the posterior end of the spleen. The omental bag also has lower gland recess, which is located between the gastrocolic ligament in front and above and the posterior plate of the greater omentum, fused with the transverse colon and its mesentery, behind and below. Omental bag through gland hole(foramen of Winslow), communicates with the hepatic bursa. The hole is small, 2-3 cm in diameter (1-2 fingers fit into it), located behind the hepatoduodenal ligament, at its free right edge. The omental opening is bounded above by the caudate lobe of the liver, below by the upper part of the duodenum, and behind by the parietal peritoneum covering the inferior vena cava.

Middle floor The peritoneal cavity is located downward from the transverse colon and its mesentery, passes into the lower floor, located in the pelvic cavity. Between the right lateral wall of the abdominal cavity, on the one hand, and the cecum and ascending colon, on the other, there is a narrow vertical gap, called right paracolic sulcus, which is also called the right side channel. Left paracolic sulcus(left lateral canal), located between the left wall of the abdominal cavity on the left, the descending colon and sigmoid colon on the right.

Part of the middle floor of the peritoneal cavity, bounded on the right, above and on the left by the colon, is divided by the mesentery of the small intestine into two fairly large fossae - the right and left mesenteric sinuses (sinuses). Right mesenteric sinus has the outline of a triangle, the apex of which faces down and to the right, towards the final section of the ileum. The walls of the right mesenteric sinus are formed on the right by the ascending colon, on top by the root of the mesentery of the transverse colon, on the left by the root of the mesentery of the small intestine. In the depth of this sinus, retroperitoneally, there are the final section of the descending part of the duodenum and its horizontal (lower) part, the lower part of the head of the pancreas, a segment of the inferior vena cava from the root of the mesentery of the small intestine below to the duodenum above, the right ureter, vessels, nerves and lymph nodes. Left mesenteric sinus also has the shape of a triangle, but its apex faces up and to the left, towards the left bend of the colon. The boundaries of the left mesenteric sinus are on the left - the descending colon and the mesentery of the sigmoid colon, on the right - the root of the mesentery of the intestine. Below, this sinus does not have a clearly defined boundary and communicates freely with the pelvic cavity (with the lower floor of the peritoneal cavity). Within the left mesenteric sinus, retroperitoneally, are the ascending part of the duodenum, the lower half of the left kidney, the terminal part of the abdominal aorta, the left ureter, vessels, nerves and lymph nodes.

The parietal layer of the peritoneum, covering the posterior wall of the abdominal cavity, forms folds and depressions - pits - in the places of transition from one organ to another or between the edge of the organ and the abdominal wall. These depressions are the site of possible formation of retroperitoneal hernias.

Thus, between the duodenum-jejunal flexure on the right and the upper duodenal fold on the left there are small amounts superior and inferior duodenal recesses. At the point where the ileum enters the cecum, the peritoneum forms folds that limit superior and inferior ileocecal recesses, located respectively above and below the terminal ileum. The cecum, covered on all sides by peritoneum, is located in the right iliac fossa. The posterior surface of the intestine, covered with peritoneum, can be seen when it is pulled anteriorly and upward. At the same time, they are clearly visible cecal folds of peritoneum, running from the surface of the iliacus muscle to the lateral surface of the cecum. Available here retrocolic recess located under the lower part of the cecum.

The sigmoid colon has a mesentery, the size of which varies depending on the size of the colon. On the left side of the mesentery of this intestine, in the place where the left leaf of the mesentery is attached to the wall of the pelvis, there is a small intersigmoid recess.

Downstairs peritoneal cavity The peritoneum, descending into the pelvic cavity, covers not only the upper and partially middle sections of the rectum, but also the organs of the genitourinary apparatus.

In men, the peritoneum covering the anterior surface of the rectum passes to the posterior and then the upper wall of the bladder. Further, the peritoneum continues into the parietal peritoneum of the anterior abdominal wall. Forms between the bladder and rectum rectovesical recess, limited on the sides rectovesical folds. These folds run in the anteroposterior direction from the lateral surfaces of the rectum to the bladder. In women, the peritoneum passes from the anterior surface of the rectum to the posterior wall of the upper part of the vagina, and then rises upward, covering the back and then the front of the uterus and fallopian tubes and goes to the bladder. Forms between the uterus and rectum rectouterine recess. It is limited on the sides rectal-uterine folds. Forms between the uterus and bladder vesicouterine recess(Fig. 32).

Knowledge of the structural features and location of the abdominal organs is important for understanding many pathological processes. The abdominal cavity contains the digestive and excretory organs. must be described taking into account the relative position of these organs.

General information

Abdomen - the space between the sternum and pelvis

The abdomen refers to the space of the body between the chest and pelvis. Basis internal structure The abdomen is the abdominal cavity containing the digestive and excretory organs.

Anatomically, the area is limited by the diaphragm, located between the thoracic and abdominal cavities. The pelvic region begins at the level of the pelvic bones.

The structural features of the abdomen and abdominal cavity are determined by many pathological processes. The digestive organs are held together with the help of a special connective tissue, mesentery.

This tissue has its own characteristics of blood supply. The abdominal cavity also contains organs of other important systems - kidneys and.

Many large blood vessels nourish the tissues and organs of the abdominal cavity. In this anatomical region, the aorta and its branches, the inferior genital vein and other large arteries and veins are distinguished.

The organs and main vessels of the abdominal cavity are protected by muscular layers that form external structure belly.

External structure and abdominal muscles

Structure of the abdomen: internal organs

The external structure of the abdomen is no different from the structure of other anatomical regions of the body. The most superficial layers include the skin and subcutaneous fat.

The subcutaneous fat layer of the abdomen can be developed to varying degrees in people with different constitutional types. The skin, fat and subcutaneous fascia contain a large number of arteries, veins and nerve structures.

The next layer of the abdomen contains the muscles. The abdominal area has a fairly powerful muscle structure that allows it to protect the abdominal organs from external physical influence.

The abdominal wall consists of several paired muscles, the fibers of which are intertwined in different places. Main abdominal muscles:

External oblique muscle. This is the largest and most superficial paired abdominal muscle. It originates from the eight lower ribs. Fibers of the external oblique muscle are involved in the formation of a dense aponeurosis of the abdomen and inguinal canal, which contains the structures of the reproductive system.
Internal oblique muscle. This is the structure of the intermediate layer of paired abdominal muscles. The muscle originates from the iliac crest and part of the inguinal ligament. Individual fibers are also associated with the ribs and pubic bones. Like the external muscle, the internal oblique muscle is involved in the formation of the wide abdominal aponeurosis.
Transverse abdominis muscle. This is the deepest muscle of the superficial layer of the abdomen. Its fibers are connected to the ribs, iliac crest, inguinal ligament, fascia of the chest and pelvis. The structure also forms the aponeurosis and inguinal canal.
Rectus abdominis muscle. It is a long muscle associated with the ribs, sternum and pubic bone. It is this muscle layer that forms the so-called abdominal press, which is clearly visible in physically developed people. The functions of the rectus abdominis muscle are associated with flexion of the body, obstetric processes, defecation, urination and forced exhalation.
Pyramidalis muscle. It is a triangular muscle structure located in front of the lower part of the rectus abdominis muscle. The fibers of the pyramidalis muscle are connected to the pubic bones and the linea alba. The muscle may be absent in 20% of people, which is due to the individual characteristics of the abdominal structure.
The aponeuroses and muscle lines of the abdomen are of particular importance in protecting and maintaining the shape of the abdominal structures. In addition, the abdominal muscles form the inguinal canal, which contains the spermatic cord in men and the round ligament of the uterus in women.

Abdomen

Abdominal structure: muscles

The internal structure of the abdomen is represented by the abdominal cavity. The cavity is lined from the inside by peritoneum, which has internal and external layers.

Between the layers of the peritoneum are the abdominal organs, blood vessels and nerve formations. In addition, the space between the layers of the peritoneum contains a special liquid that prevents friction.

The peritoneum not only nourishes and protects the structures of the abdomen, but also anchors the organs. The peritoneum also forms what is called mesenteric tissue, which is connected to the abdominal wall and abdominal organs.

The boundaries of the mesenteric tissue extend from the pancreas and small intestine to the lower parts of the colon. The mesentery secures organs in a certain position and nourishes tissues with the help of blood vessels.

Some abdominal organs are located directly in the abdominal cavity, others in the retroperitoneal space. Such features are determined by the position of the organs relative to the layers of the peritoneum.

Abdominal organs

Abdomen

The organs located in the abdominal cavity belong to the digestive, excretory, immune and hematopoietic systems.

Their mutual arrangement ensures the performance of many joint functions.

Main organs of the abdomen:

Liver. The organ is located in the right abdomen directly below the diaphragm. The functions of this organ are related to the processes of digestion, detoxification and metabolism. All nutritional components formed as a result of digestion enter the liver cells along with the blood, where chemical compounds harmful to the body are neutralized. The liver is also involved in the formation of bile, which is necessary for the digestion of fats.
Stomach. The organ is located in the left abdomen under the diaphragm. This is an extended part of the digestive tract, connected to the esophagus and the initial part of the small intestine. The key processes of chemical decomposition of food substrates occur in the stomach. In addition, stomach cells help absorb vitamin B12, which is necessary for the functioning of body cells. Hydrochloric acid contained in the stomach helps destroy bacteria.
Gallbladder. The organ is located under the liver. The gallbladder is a storage facility for bile. When food components enter the duodenum for digestion, the gallbladder secretes bile into the intestinal cavity.
Pancreas. This structure is located below the stomach between the spleen and duodenum. The pancreas is an indispensable digestive organ necessary for the final processes of food digestion. The gland produces enzymes that make it possible to convert large food components into the structural units necessary for cells. The role of the pancreas in glucose metabolism is also very important. The gland secretes insulin and glucagon, which control blood sugar.
Spleen. The organ is located in the left region of the abdomen next to the stomach and pancreas. It is an organ of hematopoiesis and immunity, allowing the deposition of blood components and the disposal of unnecessary cells.
Small and large intestines. The main processes of digestion and assimilation of food substrates occur in the sections of the small intestine. The large intestine produces and stores feces and also absorbs water.
Kidneys. These are paired excretory organs that filter the bloodstream and dispose of metabolic waste. The kidneys are connected to the ureters, bladder and urethra. In addition, the kidneys secrete a number of important substances necessary for the synthesis of vitamin D and the formation of red blood cells.

The close proximity of the abdominal organs determines the characteristics of many diseases. Inflammatory processes associated with the entry of bacteria into the abdominal cavity, can be deadly.

Methods for examining abdominal organs

Intestines: human anatomy

Numerous diagnostic methods allow you to assess the condition of the abdominal organs and, if necessary, confirm the presence of the disease.

Doctors begin with a physical examination of the patient, which allows them to detect external manifestations of pathologies. The next stage of diagnosis is the appointment of instrumental research methods.

Methods for examining the abdominal organs:

Esophagogastroduodenoscopy. A flexible tube equipped with a camera is inserted through the mouth into the patient's digestive tract. The device allows you to assess the condition of the esophagus, stomach and duodenum.
Colonoscopy. In this case, the tube is inserted into the lower digestive tract through the anus. The procedure allows you to examine the rectum and colon.
X-ray and computed tomography. The methods allow you to take pictures of the abdominal cavity.
Magnetic resonance imaging. This highly accurate method is often used for detailed examination of the liver, pancreas and gallbladder.
Ultrasound diagnostics. Using the procedure, the general condition of the abdominal organs is assessed.

Specialized techniques, including biopsy and breath testing, may be used to diagnose specific diseases.

Thus, the structure of the abdomen is important not only from the point of view anatomical features, but also from the point of view of diagnosing diseases.

The following video will introduce you to the anatomy of the human abdominal cavity:

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BORDERS, AREAS AND DEPARTMENTS OF THE ABDOMEN

The abdomen is bounded above by the costal arches, below by the iliac crests, inguinal ligaments and the upper edge of the pubic fusion. The lateral border of the abdomen runs along vertical lines connecting the ends of the 11th ribs with the anterosuperior spines.

The abdomen is divided into three sections by two horizontal lines: the epigastrium (epigastrium), the womb (mesogastrium) and the hypogastrium (hypogastrium). The outer edges of the rectus abdominis muscles run from top to bottom and divide each section into three areas.

Rice. 15.1. Dividing the abdomen into sections and areas:

1 - projection of the diaphragm dome;

2 - linea costarum; 3 - linea spmarum; a - epigastrium; b - womb; c - hypogastrium; I - the epigastric region itself; II and III - right and left subcostal areas; V - umbilical region; IV and VI - right and left lateral areas; VIII - suprapubic region; VII and IX - ilioinguinal areas

ANTEROLATERAL ABDOMINAL WALL

The anterolateral abdominal wall is a complex of soft tissues located within the borders of the abdomen and covering the abdominal cavity.

Projection of organs onto the anterolateral abdominal wall

The liver (right lobe), part of the gallbladder, hepatic flexure of the colon, right adrenal gland, part of the right kidney are projected into the right hypochondrium.

Projected into the epigastric region proper are the left lobe of the liver, part of the gallbladder, part of the body and pyloric part of the stomach, the upper half of the duodenum, the duodenum-jejunal junction (flexure), the pancreas, parts of the right and left kidneys, the aorta with the celiac trunk, the celiac plexus, a small section of the pericardium, the inferior vena cava.

The fundus, cardia and part of the body of the stomach, the spleen, the tail of the pancreas, part of the left kidney and part of the left lobe of the liver are projected into the left hypochondrium.

The ascending colon, part of the ileum, part of the right kidney and the right ureter are projected into the right lateral region of the abdomen.

Projected into the umbilical region are part of the stomach (greater curvature), transverse colon, loops of the jejunum and ileum, part of the right kidney, aorta, and inferior vena cava.

The descending colon, loops of the jejunum, and the left ureter are projected into the left lateral region of the abdomen.

The cecum with the vermiform appendix and the terminal section of the ileum are projected into the right ilioinguinal region.

The loops of the jejunum and ileum, the bladder in a full state, and part of the sigmoid colon (transition to the rectum) are projected into the suprapubic region.

The sigmoid colon and loops of the jejunum and ileum are projected into the left ilioinguinal region.

The uterus normally does not protrude beyond the upper edge of the pubic symphysis, but during pregnancy, depending on the period, it can be projected into the suprapubic, umbilical or epigastric region.

Topography of layers and weak spots of the anterolateral abdominal wall

The skin of the area is mobile and elastic, which allows it to be used for plastic purposes in the plastic surgery of facial defects (Filatov’s stem method). The hairline is quite well developed.

Subcutaneous fatty tissue is divided into two layers by the superficial fascia, the degree of its development may vary from person to person. In the navel area, fiber is practically absent, along the white line it is poorly developed.

The superficial fascia consists of two layers - superficial and deep (Thompson's fascia). The deep leaf is much stronger and denser than the superficial one and is attached to the inguinal ligament.

The fascia propria covers the abdominal muscles and fuses with the inguinal ligament.

The external oblique abdominal muscle is located most superficially. It consists of two parts: muscular, located more laterally, and aponeurotic, lying anterior to the rectus abdominis muscle and involved in the formation of the rectus sheath. The lower edge of the aponeurosis thickens, turns down and inward and forms the inguinal ligament.

The internal oblique abdominal muscle is located deeper. It also consists of a muscular and aponeurotic part, but the aponeurotic part has a more complex structure. The aponeurosis has a longitudinal fissure located about 2 cm below the navel (Douglas line, or arcuate). Above this line, the aponeurosis consists of two leaves, one of which is located anterior to the rectus abdominis muscle, and the other posterior to it. Below the line of Douglas, both leaves merge with each other and are located anterior to the rectus muscle.

The rectus abdominis muscle is located in the middle part of the abdomen. Its fibers are directed from top to bottom. The muscle is divided by 3-6 tendon bridges and lies in its own vagina, formed by the aponeuroses of the internal and external oblique and transverse abdominal muscles. The anterior wall of the vagina is represented by an aponeurosis

external oblique and partially internal oblique abdominal muscles. It is loosely separated from the rectus muscle, but fuses with it in the area of the tendon jumpers. The posterior wall is formed by the aponeurosis of the internal oblique (partially), the transverse abdominal muscles and the intra-abdominal fascia and does not fuse anywhere with the muscle, forming a cellular space in which the upper and lower epigastric vessels pass. In this case, the corresponding veins in the navel area connect with each other and form a deep venous network. In some cases, the rectus abdominis muscle is supported from below by the pyramidal muscle.

The transverse abdominal muscle lies deeper than all the others. It also consists of muscular and aponeurotic parts. Its fibers are arranged transversely, while the aponeurotic part is much wider than the muscular part, as a result of which there are small slit-like spaces at the place of their transition. The transition of the muscle part to the tendon part looks like a semicircular line called the semilunar line, or Spigel's line.

According to the Douglas line, the aponeurosis of the transverse abdominal muscle also splits: above this line it passes under the rectus abdominis muscle and participates in the formation of the posterior wall of the rectus sheath, and below the line it participates in the formation of the anterior wall of the vagina.

Under the transverse muscle is the intra-abdominal fascia, which in the area under consideration is called the transverse fascia (after the muscle on which it lies).

It should be noted that the aponeuroses of the left and right oblique and transverse abdominal muscles along the midline fuse with each other, forming the linea alba. Considering the relative paucity of blood vessels, the presence of connections between all layers and sufficient strength, it is the linea alba that is the site of the fastest surgical access for interventions on the internal organs of the abdomen.

Abdominal cavity- the largest cavity in the human body. The abdominal cavity is limited from above by the diaphragm, below it continues into the pelvic cavity, in front and on the sides it is limited by the abdominal muscles, and behind by the lumbar muscles and the corresponding part of the spinal column. The inner surface of the abdominal cavity is lined with retroperitoneal fascia, fatty tissue and parietal peritoneum.

The abdominal cavity is divided into the peritoneal cavity and the retroperitoneal space. The peritoneal cavity is limited by the parietal layer of the peritoneum. The retroperitoneal space is the part of the abdominal cavity lying between the parietal fascia of the abdomen at its posterior wall and the parietal peritoneum.

Peritoneum- serous membrane covering the inside of the abdominal cavity walls (parietal peritoneum) or the surface of internal organs (visceral peritoneum). Both layers of the peritoneum, passing one into the other, form a closed space, which is the peritoneal cavity. Normally, this cavity is a narrow gap filled with a small amount of serous fluid, which acts as a lubricant to facilitate the movements of the abdominal organs relative to the walls or each other. The amount of serous fluid usually does not exceed 25-30 ml, the pressure is approximately equal to atmospheric pressure.

Laparotomy (chromectomy)– a mandatory stage of all operations on the abdominal organs. In some cases, it serves as access to a specific organ or pathological process, in others it is used to inspect the abdominal organs in order to exclude damage to internal organs or determine the possibility of surgery for a tumor process.

Accesses. Most often, an incision along the midline of the abdomen is used - a median laparotomy.

With an upper midline laparotomy, i.e. an incision in the midline above the navel, the skin, subcutaneous tissue, aponeurosis (or linea alba), preperitoneal tissue and peritoneum are dissected. This incision provides access to the organs of the upper abdominal cavity. The inferomedian incision also runs along the linea alba, however, after dissecting the linea alba, which is very narrow below the navel, it is often necessary to use Farabeuf plate hooks to retract the edges of the rectus muscles. The incision provides access to the intestines and pelvic organs. With a mid-median laparotomy, the incision starts above the navel, goes around the navel on the left and ends 3-4 cm below it. This access is intended for revision of the entire abdominal cavity: if necessary, it can be extended up or down.

Pathways for the spread of pus in the abdominal cavity during peritonitis (diagram)

Peritoneal exudate can spread from the right hypochondrium into the right subphrenic cavity or penetrate through the right lateral canal into the iliac fossa and descend into the pelvis. As the process progresses and exudate accumulates, pus moves along the left lateral canal into the left subphrenic cavity (Fig. 95). Significant changes occur in the blood and lymphatic vessels of the intestine, the omentum and adjacent tissues and organs. First, the vessels fill with blood, then blood clots appear. This process can spread to large venous trunks and even the portal vein. The purulent thrombophlebitis that develops in these cases leads to the formation of multiple liver abscesses. Damage to the purulent process of lymphatic vessels and nodes leads to mesenteric and retroperitoneal lymphangitis and lymphadenitis.

The concept of rational drainage of the abdominal cavity includes a set of techniques that ensure the unhindered outflow of fluid from the abdominal cavity. First of all, we mean ensuring the outflow of pus during peritonitis - the primary task of treating any purulent process.

Successful drainage of the abdominal cavity is possible only if the following conditions are met: the drainage must be located in places where fluid accumulates and be passable. It is installed in sloping areas of the abdominal cavity and some of its pockets, and the patient is recommended a position in bed that promotes the best drainage. With peritonitis, as a rule, an elevated position is indicated; in some cases, a position on the side or back is required. It is more difficult to ensure drainage patency. For drainage purposes, the introduction of rubber tube drains, as well as drains made of synthetic materials, is widespread.

X. Developmental defects

XI. Operations

I. Definition of the concept of “belly”.

Borders of the abdomen (upper and lower)

Stomach(abdomen) - the lower half of the body.

Upper border of the abdomen form

front– xiphoid process and edges of costal arches,

behind– edges of the XII ribs and XII thoracic vertebra.

Lower border of the abdomen passes along lines drawn from the symphysis of the pubic bones to the sides, to the pubic tubercles, then along the inguinal folds, to the anterior superior spines of the iliac bones, along their crests and the base of the sacrum.

II. The concept of the abdominal wall and the abdominal cavity (abdominal cavity). Boundaries of the abdominal cavity

Stomach includes the abdominal wall and abdominal cavity.

Abdominal wall- a set of soft tissues that limit the abdominal cavity from the front, back and sides.

From the inside abdominal cavity lined intra-abdominal fascia .

Abdomen (abdominal cavity– cavum abdominis) - the space delimited by the intra-abdominal fascia (i.e., this is the cavity of the fascial sac ).

Abdominal cavity (abdominal cavity) delimited

above diaphragm,

front- rectus muscles and aponeuroses of the oblique and transverse abdominal muscles,

from the sides- the muscular parts of these muscles,

behind- lumbar spine, psoas major, latissimus dorsi and quadratus muscle lower back,

from below- passes into the pelvic cavity (conditional border - a plane located at the level of the boundary line), therefore the abdominal cavity is limited from below iliac bones and the pelvic diaphragm.

In the abdominal cavity (abdominal cavity) organs of the digestive and genitourinary systems, large vessels and nerve plexuses are located.

Above part of the abdominal organs is located within the boundaries chest, A down - in the small pelvis.

IV. Peritoneum (parietal and visceral).

V. Location of the abdominal organs in relation to the peritoneum (intraperitoneal, mesoperitoneal and extraperitoneal)

Abdominal organs in relation to the peritoneum may be

Intraperitoneal,

Mesoperitoneal and

Extraperitoneal.

1) An organ covered by peritoneum on all sides , located intraperitoneally (intraperitoneal) .

Intraperitoneal (intraperitoneal) located stomach, jejunum, ileum, cecum, appendix, transverse colon, sigmoid colon, upper part of the rectum. They are covered with visceral peritoneum on all sides, except for the attachment points of the mesenteries. Also located intraperitoneally are the bulb (initial part) of the duodenum, the tail of the pancreas, the spleen, the uterus, the fallopian tubes, and the ovaries.

2) An organ covered by peritoneum on three sides and not covered by peritoneum on one side, located mesoperitoneal.

Bodies occupying mesoperitoneal position (covered by peritoneum on three sides): liver, gall bladder, ascending and descending colon, middle part (ampullary part) of the rectum, full bladder.

3) An organ covered by peritoneum on only one surface , located retroperitoneal (extraperitoneal) .

Extraperitoneal ( extraperitoneal) located duodenum(except for its initial section - the bulb), pancreas (except for its tail), lower part of the rectum, empty bladder, kidneys , ureters , adrenal glands , the abdominal aorta, the inferior vena cava and other large vessels that are located in the retroperitoneal space.

VI. Sections and areas of the anterolateral abdominal wall.

Anterior abdominal wall located between the right and left posterior axillary lines (anterior to them).

It is divided into departments two lines (planes) drawn

- horizontally between the lowest points of the X edges ( subcostal plane) or horizontally through the middle of the distance between the upper edge of the manubrium and the pubic symphysis ( transpyloric plane) And

- between the superior anterior iliac spines ( interosseous plane) or between the iliac tuberosities ( intercrestal plane).

These departments are:

epigastrium(epigastrium),

womb(mesogastrium) and

hypogastrium(hypogastrium).

Two vertical lines ( midclavicular lines), which run along the lateral edges of the rectus abdominis muscles, divide the anterior abdominal wall for 9 regions.

Rice. 6. Areas of the anterior abdominal wall:

1 - right hypochondrium; 2 - epigastric; 3 - left hypochondrium; 4 - right side; 5 - umbilical; 6 - left side; 7 - right inguinal; 8 - pubic; 9 - left inguinal.

X. Developmental defects

Disturbances in the normal development of the anterior abdominal wall and the formation of the abdominal cavity may cause fetal hernia . With such a hernia, emergency surgery is indicated, because drying of the thin membranes that cover the hernial contents leads to rupture of the membranes, eventration and peritonitis.

In case of underdevelopment of the diaphragm, congenital diaphragmatic hernia , caused by the presence of a hole in the diaphragm dome (usually on the left).

Disruption of the process of attachment of the primary mesentery to the posterior layer of the parietal peritoneum after completion of the intestinal rotation may cause the formation of other internal abdominal hernias (perioduodenal hernia of Treitz, peri-cecal, intersigmoid, etc.).

XI. Operations

The main surgical access to the abdominal organs is laparotomy .

Depending on the location of the organ on which it is performed surgery, the nature of the pathology and the scope of the operation, various incisions are used for access.

Most often used midline laparotomy, in which the abdominal cavity is opened along the white line of the abdomen.

During operations on the organs of the retroperitoneal space, lumbotomy - incision in the lumbar region (extraperitoneal access).

TOPIC: “Topographic anatomy of the abdomen. General characteristics. Abdominal areas"

I. Definition of the concept “stomach”. Borders of the abdomen (upper and lower).

II. The concept of the abdominal wall and the abdominal cavity (abdominal cavity). Borders of the abdominal cavity.

III. Two sections of the abdominal cavity (the abdominal cavity itself and the retroperitoneal space).

IV. Peritoneum (parietal and visceral). Peritoneal cavity (peritoneal cavity).

V. The location of the abdominal organs in relation to the peritoneum (intraperitoneal, mesoperitoneal and extraperitoneal).

VI. Sections and areas of the anterolateral abdominal wall.

VII. Projections of organs onto the areas of the anterolateral abdominal wall.

VIII. Individual and age differences in the position of the abdominal organs.

IX. Blood supply, lymphatic drainage, innervation of abdominal organs.

X. Developmental defects